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Bone syphilis
NW Swics Vc,r . II,
No.
,
Progress
complete sacraIization. Most authors say that there must be contact with the sacrum to constitute sacrahzation and that the first degree given above shouId therefore not be counted, but it sometimes causes the same painful syndrome as a true sacralization and may be caIIed a pseudo-sacralization. Different” degrees of sacrahzation may exist on the two sides. Anatomic sacraIization sometimes exists without causing any symptoms. The pain syndrome appears most frequentIy in men between twenty and forty years of age and is generaIIy diagnosed as sciatica or Iumbalgia. PhysicaI examination often shows that the vertebra1 coIumn has Iost its normaI Iordosis and is straight; and there may be scoliosis of different degrees, crossed or homologous. DifferentiaI diagnosis from tubercuIous spondyIitis, spondyIoIisthesis and traumatic by roentgen spondvlitis examination. Y?aIZbIemmZhod of differentiation from sciaticas not caused by sacrahzation is to inject a IocaI anesthetic to determine the segment from which the lesion originates. The roentgen picture may be confused in some by superimposed shadows. The fifth cases Iumbar vertebra may be more or Iess wedged into the interiliac space and the shadows of the transverse processes, the highest part of the wing of the sacrum and the highest part of the iIium may be superimposed. The condition is probabIy due to atavism. In examining the skeIetons of anthropoid apes the author found that they have a symmetrical and biIatera1 fusion of the fifth Iumbar with the sacrum, and in the South American natives there is often such a sacralization also. There may be an infectious or traumatic cIement added to the sacraIization in the causation of the pain syndrome and treatment for that should first be given. If medical and roentgen treatment are not effective, the transverse process or processes should bc resected. DILLINGHAILI, FREDERICK H., AND MCCAFFERTY, LAWRENCE K. Bone syphihs. Am. J. .!$$I., July, 1926, x, 373-382. Three cases are reported; one of earIy periostitis, one of the thickening of the periosteum with osteoporosis of the bone cortex, and one of extensive osteomyeIitis with thickening of the bone cortex and eIevation of the periosteum. When syphilis of the bone exists for any Length of time there is present not onIy periostitis but at the same time various phases of bone pathoIogy such as scIerosis, rarefaction and osteomyeIitis. It is onIy in the beginning of bone syphrbs that one sees the wavy, irregular
in Surgery
American
Journnl
oE Sur~rry
85
Iine of the periosteum in the roentgenogram, which almost aIways signifies syphilitic periostitis. This picture is seen so frequently, that sight may be Iost of the fact that syphilis may aIso cause the other definite Iesions mentioned above. One shouId be on the Iookout for syphilis at the first sign of nocturna1 pain. One shouId not treat too IightIy the “aches and pains” of middIe Iife, but should attempt to assign a definite cause rather than to cIassify them a11 under neurasthenia, rheumatism, etc. A roentgenogram shouId aIways foIIow a negative Wassermann reaction in cases presenting persistent nocturna1 pains whether or not the history is suggestive of syphiIis. The roentgenoIogist may not be abIe aIways to definitely differentiate bone syphiIis from tubercuIosis and other diseases of bone, but he can frequentIy aid the syphiIoIogist in arriving at a tentative diagnosis. At times it may be necessary to resort to the therapeutic test, but this IS infrequent. EADES, M. F. Postoperative massive ateIectasis. Boston M. CY S. J., Aug. 5, 1926, cxcv, 258-263. Postoperative massive ateIectasis is a frequentIy unrecognized pulmonary complication. The diagnosis is important in order to eIiminate more serious conditions with which it may be confused. The cardina1 cIinica1 sign is displacement of the heart toward the affected side. In the invoIvement of the right Iung, the cardiac impuIse is frequentIy found at the left border of the sternum. If the Icft lung is affected the cardiac impulse may be found on the Ieft anterior or mid-axillarv line. The position of the heart shouId be verified roentgenographicaIIy in a11 suspected cases. This is especiaIIy important in the recognition of cases in which the Iung invoIvement and the cardiac dispIacement are slight. In extensive invoIvement the affected Iung shows a remarkabIe degree of uniform density comparabIe in some instances to that of the carciiac shadow. In some cases a definite deviation of the trachea towarc the affected side is aIso evident. The roentgenogram may be the only means of differentiating this condition from embolism or infarct, owing to the varying cIegrees of the clinica signs and symptoms. It is beIieved that bronchia obstruction and weakenec1 respiratory movement in varying combinations produce postoperative massive aterectasis. The prognosis in cases of unilateral coIlapse is exceIIent; in biIatera1 involvement the outcome is IiabIe to be fatal. No treatment has been found which influences the course of the condition.
No.
,
Progress
complete sacraIization. Most authors say that there must be contact with the sacrum to constitute sacrahzation and that the first degree given above shouId therefore not be counted, but it sometimes causes the same painful syndrome as a true sacralization and may be caIIed a pseudo-sacralization. Different” degrees of sacrahzation may exist on the two sides. Anatomic sacraIization sometimes exists without causing any symptoms. The pain syndrome appears most frequentIy in men between twenty and forty years of age and is generaIIy diagnosed as sciatica or Iumbalgia. PhysicaI examination often shows that the vertebra1 coIumn has Iost its normaI Iordosis and is straight; and there may be scoliosis of different degrees, crossed or homologous. DifferentiaI diagnosis from tubercuIous spondyIitis, spondyIoIisthesis and traumatic by roentgen spondvlitis examination. Y?aIZbIemmZhod of differentiation from sciaticas not caused by sacrahzation is to inject a IocaI anesthetic to determine the segment from which the lesion originates. The roentgen picture may be confused in some by superimposed shadows. The fifth cases Iumbar vertebra may be more or Iess wedged into the interiliac space and the shadows of the transverse processes, the highest part of the wing of the sacrum and the highest part of the iIium may be superimposed. The condition is probabIy due to atavism. In examining the skeIetons of anthropoid apes the author found that they have a symmetrical and biIatera1 fusion of the fifth Iumbar with the sacrum, and in the South American natives there is often such a sacralization also. There may be an infectious or traumatic cIement added to the sacraIization in the causation of the pain syndrome and treatment for that should first be given. If medical and roentgen treatment are not effective, the transverse process or processes should bc resected. DILLINGHAILI, FREDERICK H., AND MCCAFFERTY, LAWRENCE K. Bone syphihs. Am. J. .!$$I., July, 1926, x, 373-382. Three cases are reported; one of earIy periostitis, one of the thickening of the periosteum with osteoporosis of the bone cortex, and one of extensive osteomyeIitis with thickening of the bone cortex and eIevation of the periosteum. When syphilis of the bone exists for any Length of time there is present not onIy periostitis but at the same time various phases of bone pathoIogy such as scIerosis, rarefaction and osteomyeIitis. It is onIy in the beginning of bone syphrbs that one sees the wavy, irregular
in Surgery
American
Journnl
oE Sur~rry
85
Iine of the periosteum in the roentgenogram, which almost aIways signifies syphilitic periostitis. This picture is seen so frequently, that sight may be Iost of the fact that syphilis may aIso cause the other definite Iesions mentioned above. One shouId be on the Iookout for syphilis at the first sign of nocturna1 pain. One shouId not treat too IightIy the “aches and pains” of middIe Iife, but should attempt to assign a definite cause rather than to cIassify them a11 under neurasthenia, rheumatism, etc. A roentgenogram shouId aIways foIIow a negative Wassermann reaction in cases presenting persistent nocturna1 pains whether or not the history is suggestive of syphiIis. The roentgenoIogist may not be abIe aIways to definitely differentiate bone syphiIis from tubercuIosis and other diseases of bone, but he can frequentIy aid the syphiIoIogist in arriving at a tentative diagnosis. At times it may be necessary to resort to the therapeutic test, but this IS infrequent. EADES, M. F. Postoperative massive ateIectasis. Boston M. CY S. J., Aug. 5, 1926, cxcv, 258-263. Postoperative massive ateIectasis is a frequentIy unrecognized pulmonary complication. The diagnosis is important in order to eIiminate more serious conditions with which it may be confused. The cardina1 cIinica1 sign is displacement of the heart toward the affected side. In the invoIvement of the right Iung, the cardiac impuIse is frequentIy found at the left border of the sternum. If the Icft lung is affected the cardiac impulse may be found on the Ieft anterior or mid-axillarv line. The position of the heart shouId be verified roentgenographicaIIy in a11 suspected cases. This is especiaIIy important in the recognition of cases in which the Iung invoIvement and the cardiac dispIacement are slight. In extensive invoIvement the affected Iung shows a remarkabIe degree of uniform density comparabIe in some instances to that of the carciiac shadow. In some cases a definite deviation of the trachea towarc the affected side is aIso evident. The roentgenogram may be the only means of differentiating this condition from embolism or infarct, owing to the varying cIegrees of the clinica signs and symptoms. It is beIieved that bronchia obstruction and weakenec1 respiratory movement in varying combinations produce postoperative massive aterectasis. The prognosis in cases of unilateral coIlapse is exceIIent; in biIatera1 involvement the outcome is IiabIe to be fatal. No treatment has been found which influences the course of the condition.