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The Other Arthritides: Roentgenologic Features of Osteoarthritis, Erosive Osteoarthritis, Ankylosing Spondylitis, Psoriatic Arthritis, Reiter’s Disease, Multicentric Reticulohistiocytosis, and Progressive Systemic Sclerosis
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PENIS, URETHRA, TRAUMA AND FISTULAS
the penis on the abdominal wall. Hospital stay has varied from Oto 72 days, with an average of 14 days. I, personally, prefer to open the defect, deb ride it, close it primarily, close the skin over it, and use compression dressings and ice packs postoperatively, with antibiotics. This surgical management is necessary in 10 to 15 per cent of the cases. Paul C. Peters, M.D. The Other Arthritides: Roentgenologic Features of Osteoarthritis, Erosive Osteoarthritis, Ankylosing Spondylitis, Psoriatic Arthritis, Reiter's Disease, Multicentric Reticulohistiocytosis, and Progressive Systemic Sclerosis
R.
H. GOLD, L. W. BASSETT AND L. L. SEEGER, Department of Radiological Sciences, UCLA School of Medicine and UCLA Medical Center, Los Angeles, California
Rad. Clin. N. Amer., 26: 1195-1212, 1988
Editorial Comment: This article is written primarily for radiologists to describe the roentgen features in the differential diagnosis of osteoarthritis, erosive osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter's disease, multicentric reticulohistiocytosis and progressive systemic sclerosis. It would be valuable for anyone who practices a specialty (including urology) in which interpretation of abdominal plain films and skeletal films is necessary. Dr. Morris Ziff, former president of the Society of Rheumatology, has stated that arthritis is in the joint and rheumatism is outside the joint. This article is valuable to discuss the roentgenographic changes of the arthritides and the differential diagnosis of these conditions. Most urologists are concerned with the differential diagnosis between osteoarthritis and rheumatoid arthritis, and one must learn to appreciate the subtler changes. By the time ankylosing spondylitis is present with marked calcification in the anterior longitudinal ligaments, the diagnosis is only of academic interest to the patient and urologist. The association of arthritis with urethritis and conjunctivitis, the so-called Reiter syndrome, has been seen by many urologists and has been shown to have a relationship to B27 HLA characteristics. Rheumatoid arthritis may be at times difficult to differentiate from Reiter's disease. Rheumatoid arthritis involves the sacroiliac joints and may be associated with severe kyphotic deformity, even early in life. The lesions are less destructive than those of osteoarthritis but striking involvement of the capsules, tendons and ligaments ultimately leads to ankylosis. The sacroiliac joints are affected early in ankylosing spondylitis. Osteoarthritis is characterized early by multiple joint involvement, degeneration secondary to articular cartilage damage, development of Heberden's nodes of the
distal interphalangeal joints, and flattening of subchondral bone with infarctions and ischemic necrosis. Psoriatic arthritis is characterized by synovial membrane inflammation, and interphalangeal marginal and surface erosions, sausage-type deformities in the distal phalanges of the fingers, severe destruction of subchondral bone, pencil and cup deformity at the distal end of a metacarpal or metatarsal bone and bony ankylosis of the interphalangeal joints. Osteophytes and bridging are seen less than in the more characteristic osteoarthritis involving the lumbar vertebra. Sacroileitis is less common in Reiter's disease than in rheumatoid arthritis. The limitation of chest expansion in the patient with rheumatoid arthritis is well known. Diffuse scleroderma may, besides the exhibition of Raynaud's-like phenomena in the distal extremities, show distal calcification of soft parts, pulmonary fibrosis thickening of the soft tissues and marked calcifications in the tips of the terminal phalanges with resorption of the bone proximal to this calcinosis circumscripta that occurs on the volar surface of the hands. The article should be read in the original version to review the excellent films of characteristic forms of arthritides. This will improve our ability to interpret films of the abdomen displaying a variety of types of arthritis. Paul C. Peters, M.D. Demonstration of a Rectovesical Fistula on a Technetium-99m MDP Bone Image
K.
HIGASHI, M. 0HGUCHI, T. 0KIMURA, T. MIYAMURA AND I. YAMAMOTO, Department of Radiology, Kanazawa
Medical College, Kanazawa, Japan Clin. Nucl. Med., 13: 625-626, 1988 Besides its usefulness in detecting osseous pathology, technetium-99m phosphate bone imaging may incidentally reveal abnormalities in genitourinary system, rarely a communication between genitourinary system and intestine. A case of rectovesical fistula demonstrated on bone imaging is presented.
Editorial Comment: A newer method to detect a rectovesical fistula, the distribution of the liquid 99mtechnetium phosphate excreted by the kidneys, may allow the demonstration of a communication between the genitourinary system and the intestine. The authors show pictures of what the scans look like. Isotope was seen easily in the transverse descending colon and rectosigmoid. Of interest is the fact that the fistula also was demonstrated well by cystography, a considerably more cost-effective procedure. The fistula followed radiation therapy and chemotherapy for squamous cell carcinoma of the cervix and a large communication was demonstrated between the bladder and colon. Paul C. Peters, M.D.
PENIS, URETHRA, TRAUMA AND FISTULAS
the penis on the abdominal wall. Hospital stay has varied from Oto 72 days, with an average of 14 days. I, personally, prefer to open the defect, deb ride it, close it primarily, close the skin over it, and use compression dressings and ice packs postoperatively, with antibiotics. This surgical management is necessary in 10 to 15 per cent of the cases. Paul C. Peters, M.D. The Other Arthritides: Roentgenologic Features of Osteoarthritis, Erosive Osteoarthritis, Ankylosing Spondylitis, Psoriatic Arthritis, Reiter's Disease, Multicentric Reticulohistiocytosis, and Progressive Systemic Sclerosis
R.
H. GOLD, L. W. BASSETT AND L. L. SEEGER, Department of Radiological Sciences, UCLA School of Medicine and UCLA Medical Center, Los Angeles, California
Rad. Clin. N. Amer., 26: 1195-1212, 1988
Editorial Comment: This article is written primarily for radiologists to describe the roentgen features in the differential diagnosis of osteoarthritis, erosive osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter's disease, multicentric reticulohistiocytosis and progressive systemic sclerosis. It would be valuable for anyone who practices a specialty (including urology) in which interpretation of abdominal plain films and skeletal films is necessary. Dr. Morris Ziff, former president of the Society of Rheumatology, has stated that arthritis is in the joint and rheumatism is outside the joint. This article is valuable to discuss the roentgenographic changes of the arthritides and the differential diagnosis of these conditions. Most urologists are concerned with the differential diagnosis between osteoarthritis and rheumatoid arthritis, and one must learn to appreciate the subtler changes. By the time ankylosing spondylitis is present with marked calcification in the anterior longitudinal ligaments, the diagnosis is only of academic interest to the patient and urologist. The association of arthritis with urethritis and conjunctivitis, the so-called Reiter syndrome, has been seen by many urologists and has been shown to have a relationship to B27 HLA characteristics. Rheumatoid arthritis may be at times difficult to differentiate from Reiter's disease. Rheumatoid arthritis involves the sacroiliac joints and may be associated with severe kyphotic deformity, even early in life. The lesions are less destructive than those of osteoarthritis but striking involvement of the capsules, tendons and ligaments ultimately leads to ankylosis. The sacroiliac joints are affected early in ankylosing spondylitis. Osteoarthritis is characterized early by multiple joint involvement, degeneration secondary to articular cartilage damage, development of Heberden's nodes of the
distal interphalangeal joints, and flattening of subchondral bone with infarctions and ischemic necrosis. Psoriatic arthritis is characterized by synovial membrane inflammation, and interphalangeal marginal and surface erosions, sausage-type deformities in the distal phalanges of the fingers, severe destruction of subchondral bone, pencil and cup deformity at the distal end of a metacarpal or metatarsal bone and bony ankylosis of the interphalangeal joints. Osteophytes and bridging are seen less than in the more characteristic osteoarthritis involving the lumbar vertebra. Sacroileitis is less common in Reiter's disease than in rheumatoid arthritis. The limitation of chest expansion in the patient with rheumatoid arthritis is well known. Diffuse scleroderma may, besides the exhibition of Raynaud's-like phenomena in the distal extremities, show distal calcification of soft parts, pulmonary fibrosis thickening of the soft tissues and marked calcifications in the tips of the terminal phalanges with resorption of the bone proximal to this calcinosis circumscripta that occurs on the volar surface of the hands. The article should be read in the original version to review the excellent films of characteristic forms of arthritides. This will improve our ability to interpret films of the abdomen displaying a variety of types of arthritis. Paul C. Peters, M.D. Demonstration of a Rectovesical Fistula on a Technetium-99m MDP Bone Image
K.
HIGASHI, M. 0HGUCHI, T. 0KIMURA, T. MIYAMURA AND I. YAMAMOTO, Department of Radiology, Kanazawa
Medical College, Kanazawa, Japan Clin. Nucl. Med., 13: 625-626, 1988 Besides its usefulness in detecting osseous pathology, technetium-99m phosphate bone imaging may incidentally reveal abnormalities in genitourinary system, rarely a communication between genitourinary system and intestine. A case of rectovesical fistula demonstrated on bone imaging is presented.
Editorial Comment: A newer method to detect a rectovesical fistula, the distribution of the liquid 99mtechnetium phosphate excreted by the kidneys, may allow the demonstration of a communication between the genitourinary system and the intestine. The authors show pictures of what the scans look like. Isotope was seen easily in the transverse descending colon and rectosigmoid. Of interest is the fact that the fistula also was demonstrated well by cystography, a considerably more cost-effective procedure. The fistula followed radiation therapy and chemotherapy for squamous cell carcinoma of the cervix and a large communication was demonstrated between the bladder and colon. Paul C. Peters, M.D.