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Thirty patients of both sexes (15 males and 15 females) with chronic renal failure who had under gone hemodialysis for 2-184 months (mean 45.1 months) were examined with conventional radiographs of the cervical spine and thin-layer CT of C4-C5-C6 to evaluate the radiographic patterns of destructive spondyloarthropathy. The radiographic patterns obtained with conventional and CT exams were compared with one another and with clinical (carpal tunnel syndrome) and biochemical data (alkaline phosphatase, parathormon, Ca, P, Ca/P, Al, beta 2-microglobulin). DSA (erosion and narrowing of the intervertebral space, collapse of the vertebral body and erosion of the vertebral plates) was recognized in 7 patients with conventional radiographs and in 11 patients with CT thanks to greater CT capabilities to recognize minimal osteolytic lesions of the vertebral body. All the patients with destructive spondyloarthropathy had personal and hemodialysis age higher than those without destructive spondyloarthropathy: 59.3 vs 57.7 years; 49 vs 39 months. Parathormon and alkaline phosphatase were increased while beta 2-microglobulin was normal. Only 2 patients with DSA had carpal tunnel syndrome. In conclusion, CT is a valuable technique for the diagnosis of destructive spondyloarthropathy but it must be performed only after conventional radiographs of the cervical spine or in the presence of clinical signs of destructive spondyloarthropathy (parathormon and beta 2-microglobulin increased, long-term hemodialysis).
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PMID:[Computerized tomography and conventional radiography in the diagnosis of destructive spondyloarthropathy. Our experience with 30 patients undergoing periodic hemodialysis]. 149 70

Destructive spondyloarthropathy (DSA) has been observed in patients undergoing long-term hemodialysis. The pathophysiology of this condition is still unknown, but there is evidence that amyloid depositions play an important role in its development. Despite several reports, the radiological evolution of these lesions is poorly known. The authors report the results of the radiographic follow-up (12-18 months) of 9 cases (7 female and 2 male patients; age 63 +/- 6 years) hemodialyzed for over 60 months (mean: 126 +/- 33). In 7 cases, radiographic patterns of destructive arthropathy were seen in peripheral joints as well. X-ray pictures demonstrated: 1) increased erosion of vertebral end plates (in all cases); 2) increased narrowing of intervertebral spaces (in 5 cases); 3) increased collapse of vertebral bodies (in 5 cases); 4) increased malalignment of the involved segments (in 4 cases). In 3 autopsied cases beta 2-microglobulin amyloid depositions were found in disc and ligamentous paravertebral tissue. These results confirm that: 1) DSA is progressive in long-term hemodialysis patients; 2) radiographic evolution is often very quick; 3) the cervical spine is the most frequently involved location and the one where lesions are quickest to develop; 4) severe malalignment of the involved spine may be present, with subsequent neurological complications.
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PMID:[Course of radiologic changes in spondyloarthropathy caused by dialysis]. 201 24

Degenerative and overuse diseases as well as impingement syndromes of the hand are illustrated and discussed in this review article. Osteoarthritis of the interphalangeal joints as described by Heberden and Bouchard is a ubiquitous articular disease often associated with synovitis and erosive joint destruction. Osteoarthritis of the trapeziometacarpal joint is classified into four stages for proper indication of operation. Overuse can result in stenosing tenosynovitis around the wrist and in synovitis with or without impingement of the flexor or extensor tendons of the digitis or ruptures of the annular and cruciform pulleys. Although diagnosis of these entities is usually made by history and clinical investigation, ultrasound and MRI can be helpful tools in imaging of these diseases. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the characteristic degeneration pattern of the wrist and represent the degeneration mechanisms in scapholunate insufficiency and nonunion of the scaphoid. SLAC wrist is a gradual degeneration classified in three stages and found in posttraumatic scapholunate rupture, calcium pyrophosphate dehydrate deposition disease (CPPD), rheumatoid arthritis, neuropathic diseases, trauma, and beta 2-microglobulin associated amyloid deposition. Ulna impaction syndrome is increasingly recognized as a cause of ulnar sided pain and exhibits a characteristic MRI appearance.
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PMID:Imaging of the hand: degeneration, impingement and overuse. 928 40