Cross-cultural validation of the ICOAP and physical function short forms of the HOOS and KOOS in a multi-country study of patients with hip and knee osteoarthritis

OBJECTIVE

To evaluate the internal consistency and construct validity of the Physical Function short-forms for the Hip and Knee Injury Osteoarthritis Outcome Scores (HOOS-PS/KOOS-PS) and the Intermittent and Constant Osteoarthritis Pain (ICOAP) in a nine country study of patients consulting for total hip or knee replacement (THR or TKR).

METHODS

Patients completed HOOS-PS or KOOS-PS, ICOAP and Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) pain and physical function subscales at their consultation visit. Internal consistency was calculated using Cronbach's alpha. The association of HOOS-PS/KOOS-PS and ICOAP with WOMAC pain and function subscales was calculated with Spearman correlation coefficients with 95% confidence intervals.

RESULTS

HOOS-PS/KOOS-PS and ICOAP demonstrated high internal consistency across countries (alpha 0.75-0.96 (hip) and 0.76-0.95 (knee)). Both HOOS-PS and KOOS-PS demonstrated high correlations (0.76-0.90 and 0.75-0.91, respectively) with WOMAC function in all countries. ICOAP exhibited moderate to high correlations with WOMAC pain and function subscales (0.53-0.84 (hip) and 0.43-0.84 (knee)).

CONCLUSION

The psychometric properties of the HOOS-PS/KOOS-PS, and ICOAP were maintained across all countries.

Comparison of the prognostic value of the 6th and 7th editions of the Union for International Cancer Control TNM staging system in patients with lower esophageal cancer undergoing neoadjuvant chemotherapy followed by surgery

Carcinoma of the esophagus is classified according to the Union for International Cancer Control (UICC) TNM staging system. The 7th edition of the UICC TNM staging system was published in 2009. This is the first study to compare the prognostic value of the TNM 6th and 7th editions in patients with esophageal carcinoma treated with chemotherapy followed by surgery. Two hundred forty-three patients with esophageal carcinoma were retrospectively selected from two referral centers. All patients received chemotherapy before surgery. Histopathologic data from the resection specimens were retrieved and restaged according to the TNM 7th edition. Disease-specific survival curves were plotted for depth of tumor invasion (ypT), lymph node status (ypN), and ypTNM stage and then compared. Median follow-up after surgery was 2.5 years (range 0.2-9 years). Survival analysis using the log-rank method revealed that there was a significant difference in survival between ypT4 disease and ypT3 disease (P= 0.003), but no difference between ypT0, ypT1, ypT2, and ypT3 categories irrespective of TNM edition used. Survival probability was significantly different between ypN0 and ypN1 (P= 0.001 for TNM 6th and 7th edition), as well as ypN2 and ypN3 (TNM 7th edition, P= 0.004), but not between ypN1 and ypN2 (TNM 7th edition, P= 0.89). Neither the TNM 6th nor 7th edition T staging provides accurate survival probability stratification. However, the advantage of the 7th edition is the introduction of a third tier in survival stratification for patients with nodal involvement.

Adrenomedullary function in patients with nonclassic congenital adrenal hyperplasia

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is classified into three types based on disease severity: classic salt-wasting, classic simple virilizing, and nonclassic. Adrenomedullary dysplasia and epinephrine deficiency have been described in classic CAH, resulting in glucose dysregulation. Our objective was to investigate adrenomedullary function in nonclassic CAH and to evaluate adrenomedullary function according to disease severity. Adrenomedullary function was evaluated in response to a standardized cycle ergonometer test in 23 CAH patients (14 females, age 9-38 years; 6 salt-wasting, 7 simple virilizing, 5 nonclassic receiving glucocorticoid treatment, 5 nonclassic not receiving glucocorticoid), and 14 controls (7 females, age 12-38 years). Epinephrine, glucose, and cortisol were measured at baseline and peak exercise. CAH patients and controls were similar in age and anthropometric measures. Patients with nonclassic CAH who were not receiving glucocorticoid and controls experienced the expected stress-induced rise in epinephrine, glucose, and cortisol. Compared to controls, patients with all types of CAH receiving glucocorticoid had impaired exercise-induced changes in epinephrine (salt-wasting: p=0.01;simple virilizing: p=0.01; nonclassic: p=0.03), and cortisol (salt-wasting: p=0.004; simple virilizing: p=0.006; nonclassic: p=0.03). Salt-wasting patients displayed the most significant impairment, including impairment in glucose response relative to controls (p=0.03). Hydrocortisone dose was negatively correlated with epinephrine response (r=-0.58; p=0.007) and glucose response (r=-0.60; p=0.002). The present study demonstrates that untreated patients with nonclassic CAH have normal adrenomedullary function. The degree of epinephrine deficiency in patients with CAH is associated with the severity of adrenocortical dysfunction, as well as glucocorticoid therapy.

Decreased cerebrospinal fluid amyloid beta (1-40) levels in frontotemporal lobar degeneration

The role of amyloid metabolism in the pathophysiology of frontotemporal lobar degeneration (FTLD) has yet to be elucidated. We compared CSF levels of amyloid beta 1-40 (Abeta40) and amyloid beta 1-42 (Abeta42) in patients with FTLD (n = 21) versus patients with Alzheimer's disease (AD, n = 39) and in control subjects (n = 30). While in AD cases Abeta42 levels were lower and CSF Abeta40 levels equal to those in controls, a significant decrease in Abeta40 and increase in the CSF Abeta42/Abeta40 ratio was observed in FTLD compared with AD and control subjects. These findings favour a differential involvement of amyloid beta peptides in FTLD compared with AD.

Amyloid beta protein 1-40 and 1-42 levels in matched cerebrospinal fluid and plasma from patients with Alzheimer disease

We quantitated amyloid beta proteins 1-40 (Abeta40) and 1-42 (Abeta42), and alpha1- antichymotrypsin (ACT) in matched cerebrospinal fluid (CSF) and plasma of 50 patients with probable Alzheimer disease, and analyzed the relationships with age, sex, Mini-Mental State Examination (MMSE), and apolipoprotein E phenotype. There was no relation between CSF Abeta40 and Abeta42 levels with those of plasma. CSF and plasma Abeta40 and Abeta42 levels showed no association with age, sex, and MMSE score. There was a significant correlation between CSF ACT and plasma ACT levels. The data suggest that plasma ACT crosses the blood-brain barrier. However, a lack of correlation between CSF Abeta40 and Abeta42 levels with those of plasma suggests that Abeta in CSF and plasma originates from different sources.

Plasma and cerebrospinal fluid levels of amyloid beta proteins 1-40 and 1-42 in Alzheimer disease

BACKGROUND

In brains with AD, Abeta is a major component of diffuse plaques. Previous reports showed that CSF Abeta42 levels were lower in patients with AD than in controls. Although studies showed higher plasma Abeta42 levels in familial AD, a recent report has indicated that plasma Abeta42 levels were similar in a sporadic AD group and controls. However, no information is published on plasma Abeta40 and Abeta42 levels in relation to Apo E genotype or severity of dementia in sporadic AD.

OBJECTIVE

To examine plasma and cerebrospinal fluid (CSF) levels of amyloid beta protein 1-40 (Abeta40) and 1-42 (Abeta42) levels in patients with probable Alzheimer disease (AD) and elderly nondemented control subjects in relation to the apolipoprotein E (Apo E) genotype and dementia severity.

SETTING

Two university medical centers.

PATIENTS AND METHODS

Levels of Abeta40 and Abeta42 were measured in plasma from 78 patients with AD and 61 controls and in CSF from 36 patients with AD and 29 controls by means of a sandwich enzyme-linked immunosorbent assay.

RESULTS

Mean plasma Abeta40 levels were higher in the AD group than in controls (P = .005), but there was substantial overlap; Abeta42 levels were similar between the groups. Levels of Abeta40 and Abeta42 showed no association with sex or Mini-Mental State Examination scores. There was a significant relationship between age and Abeta40 level in controls but not in the AD group. Levels of Abeta40 were higher in patients with AD with the Apo E epsilon4 allele than in controls (P<.01). Cerebrospinal fluid Abeta40 levels were similar in the AD group and controls. However, Abeta42 levels were lower in the AD group than in controls (P<.001). The levels showed no association with severity of dementia.

CONCLUSIONS

Although mean plasma Abeta40 levels are elevated in sporadic AD and influenced by Apo E genotype, measurement of plasma Abeta40 levels is not useful to support the clinical diagnosis of AD. Lower levels of CSF Abeta42 in the AD group are consistent with previous studies.

Differential fetal and maternal contributions to the cytokine milieu in a murine model of infection-induced preterm birth

OBJECTIVE

The aim of the study was to determine the relative productions by maternal and fetal tissues of proinflammatory and anti-inflammatory cytokines in a murine model of infection-induced preterm delivery.

STUDY DESIGN

The right uterine horns of CD-1 female mice at 14.5 days of a 19- to 20-day gestation were inoculated with either sterile media or live Escherichia coli. The concentrations of cytokines within uteri, placentas, membranes, and fetal lower body segments were determined by enzyme-linked immunosorbent assay at various times after inoculation.

RESULTS

All infected tissues showed large, time-dependent increases in interleukin 1alpha, interleukin 1beta, and interleukin 6. These increases were maximal 13 hours after infection and were highest in uteri (15-60 times levels in uninfected tissues). Increases in tumor necrosis factor alpha and interleukin 1 receptor antagonist were much smaller (3 to 5 times) and were confined to the uterus. Although the uterus contained the greatest concentrations of interleukin 1alpha, interleukin 1beta, interleukin 6, and tumor necrosis factor alpha, fetal bodies and placentas contained the highest levels of interleukin 1 receptor antagonist.

CONCLUSIONS

Time-dependent increases in maternal and fetal cytokines occurred after acute bacterial infection in this murine model. The fetus and placenta may be the most significant sources of the anti-inflammatory cytokine interleukin 1 receptor antagonist during pregnancy, whereas the uterus appears to be a more important source of interleukin 1, interleukin 6, and tumor necrosis factor alpha. Interleukin 1 receptor antagonist levels within uteri were insufficiently high to effectively inhibit interleukin 1 activity during infection.

Increased plasma amyloid beta protein 1-42 levels in Down syndrome

Amyloid beta protein 1-40 (A beta40) and A beta42 levels were quantitated in plasma from 43 persons with Down syndrome (DS; 26-68 years of age), 43 age-matched normal controls, and 19 non-DS mentally retarded (MR) persons (26-91 years of age) by using a sandwich enzyme linked immunosorbent assay. A beta40 levels were higher in DS and MR than controls, but were similar between DS and MR groups. A beta42 levels were higher in DS than controls or MR persons. The ratios of A beta42/A beta40 were higher in DS than controls or MR persons. The findings are consistent with those seen in DS brains.

Increased levels of interleukin-1beta and soluble intercellular adhesion molecule-1 in cerebrospinal fluid of patients with subacute sclerosing panencephalitis

Proinflammatory cytokines (interleukin [IL]-1beta, tumor necrosis factor [TNF]-alpha, and IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured in paired cerebrospinal fluid (CSF) and serum samples from patients with subacute sclerosing panencephalitis (SSPE), multiple sclerosis (MS), or other neurologic diseases (OND) by ELISA. IL-1beta was significantly increased in CSF of the SSPE group compared with levels in the MS or OND group. IL-1beta CSF/serum ratios were higher in the SSPE than in the MS or OND group. TNF-alpha and IL-6 levels were similar in the 3 groups. CSF sICAM-1 was higher in the SSPE group than in the MS or OND group. sICAM-1 CSF/serum ratios were higher in the SSPE than the OND group. The increased CSF/serum ratios of IL-1beta and sICAM-1 in SSPE indicate synthesis of IL-1beta and sICAM-1 in the central nervous system and may be important in the pathogenesis of disease.

VARIABLE RATE IV INFUSION OF MORPHINE AND HAEMODYNAMIC RESPONSE TO LARYNGOSCOPY AND TRACHEAL INTUBATION

Haemodynamic response to laryngoscopy and tracheal intubation was studied in two groups of 45 patients each. Group I patients received variable rate infusion of morphine for 30 minutes followed by intravenous (IV) bolus dose of diazepam. Group II patients received intramuscular morphine as preanaesthetic premedication and preinduction IV bolus dose of diazepam. The method of induction of GA was same in both the groups. Systolic and diastolic blood pressure (SBP and DBP) mean arterial pressure and pulse-rate were recorded at intubation and at different time intervals upto 10 minutes after intubation. In group I patients, there was no statistically significant increase in pulse-rate and SBP following intubation but transient significant increase in DBP. In group II patients, there was statistically significant increase in pulse-rate, SBP and DBP upto 3 minutes post-intubation. Thus IV infusion of morphine in combination with IV bolus dose of diazepam proved more effective in attenuating haemodynamic response to tracheal intubation.

Entamoeba histolytica cyst passers. Clinical profile and spontaneous eradication of infection

The present study was carried out to examine whether Entamoeba histolytica cyst passers suffer from any parasite-related bowel symptoms and to assess the frequency of spontaneous eradication of this infection. The study was carried out in two parts. In part I, stool samples were collected at random from 3536 individuals living in rural communities around Delhi. E. histolytica was isolated by the culture technique in 345 (9.7%) subjects. There was no increase in the prevalence rate of bowel symptoms in the culture-positive compared to the culture-negative subjects. One hundred twenty-four (36%) of the culture-positive subjects agreed to take part in a longitudinal study; the subjects were left untreated and clinical assessment and stool examinations were carried out at three-month intervals. One hundred eighteen (95.2%) subjects had eradicated their parasite spontaneously at the end of one year; none developed any features of invasive amebiasis. Part II of the study was carried out on 625 patients attending our Gastroenterology Clinic. Positive cultures of E. histolytica were obtained from 99 (15.2%) patients. Again, there was no increase in the prevalence rate of bowel complaints in the culture-positive compared to the culture-negative subjects. Moreover, histological appearances of the rectal biopsy specimens were not significantly different between the two groups. Twenty-eight (28.2%) patients agreed to the longitudinal study and all eradicated the parasite spontaneously within five months; none developed any evidence of invasive amebiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoglobulin G subclasses in older persons with Down syndrome

IgG subclasses were measured in sera from 33 persons with Down syndrome (DS) (mean age 55 +/- 7 years) and 33 age- and sex-matched control individuals using a mouse monoclonal antibody based sandwich enzyme linked immunosorbent assay. Significantly higher levels of IgG1 and IgG3 and lower levels of IgG2 and IgG4 subclasses were found in the DS group compared to the control individuals. The higher levels of IgG1 and IgG3 subclasses found in DS persons were consistent with those seen in patients with autoimmune diseases and chronic viral infections; the lower levels of IgG2 and IgG4 subclasses were consistent with those seen in patients with recurrent infections. Our findings are similar to those reported in children with DS. We speculate that the subclass levels may have little or no relationship to the development of brain lesions typical of Alzheimer disease in older persons with DS. There were no significant differences between the levels of IgG subclasses of persons with DS showing signs of dementia of the Alzheimer type compared to those without such manifestations.

Increased levels of beta 2-microglobulin, soluble interleukin-2 receptor, and soluble CD8 in patients with subacute sclerosing panencephalitis

We measured beta 2-microglobulin (beta 2-M), soluble interleukin-2 receptor (sIL-2R), and soluble CD8 (sCD8) antigen levels in paired cerebrospinal fluid (CSF) and sera from patients with subacute sclerosing panencephalitis (SSPE), multiple sclerosis (MS), and other neurological diseases (OND) using enzyme-linked immunosorbent assay. beta 2-M was significantly increased in CSF of the SSPE group compared to the MS or the OND group. Similarly, beta 2-M in the MS versus OND group was significantly increased in CSF. Although serum levels of beta 2-M were similar in the three groups, the CSF/serum ratios were higher in SSPE versus the MS group and in the MS versus the OND group. Levels of sIL-2R and sCD8 were higher in SSPE CSF than OND CSF; however, there were no differences between levels in SSPE and MS CSF. The levels of sIL-2R were increased in SSPE sera compared to those of MS or the OND group, whereas levels of sCD8 in serum from the three groups were similar. The findings of increased CSF/serum ratio of beta 2-M and higher levels of serum sIL-2R and CSF sCD8 in SSPE patients are consistent with those seen in patients with acute and chronic viral infections. When the levels between the initial and follow-up CSF and serum samples from SSPE patients were compared, the data showed that CSF levels of sCD8 elevated during periods of clinical worsening and decreased during clinical improvement. In contrast, serum beta 2-M decreased during periods of worsening and increased during improvement. The measurement of serum beta 2-M and CSF sCD8 may be useful in SSPE patients as markers to monitor disease activity.

Distribution of IgG subclasses in human colostrum and milk

Immunoglobulin G (IgG) subclasses in human colostrum and milk were quantitated using mouse monoclonal antibodies specific for human IgG subclasses and an enzyme-linked immunosorbent assay (ELISA). The percentage of IgG1 was significantly increased and that of IgG2 was decreased in both colostrum and milk relative to the percentage distribution reported in healthy adult and maternal sera. Percentages of IgG3 and IgG4 in colostrum, milk and sera were similar. All IgG subclass concentrations decreased by 90% during the first week of lactation and remained constant thereafter. The possible antiviral role of high levels of IgG1 in colostrum and milk is discussed.

Specificity of oligoclonal IgG bands against myelin proteins in chronic relapsing EAE in guinea pigs

We showed previously by using imprint electroimmunofixation that the oligoclonal IgG in sera and CSF from chronic relapsing EAE in guinea pigs were specific to spinal cord and Mycobacterium tuberculosis. We now show that most oligoclonal IgG bands are directed predominantly against isolated myelin basic protein (MBP). Activity to the latter could be removed from sera or CSF by absorption with MBP but not with histone or lysozyme. The oligoclonal IgG reacted weakly with isolated proteolipid apoprotein, and lacked reactivity to myelin-associated glycoprotein. When the oligoclonal IgG activity to myelin proteins was removed from the sera by absorption with a preparation of delipidated myelin before imprint electroimmunofixation, a few bands in some sera still reacted with whole spinal cord homogenate. These results indicate that, in some sera, a part of the oligoclonal IgG was directed against non-myelin proteins or lipids. In contrast to chronic relapsing EAE, CSF oligoclonal IgG from patients with multiple sclerosis showed no reactivity against human brain homogenate, whole myelin, delipidated myelin, and MBP in imprint electroimmunofixation.

Quantitation of IgG and albumin in CSF and serum from multiple sclerosis patients by enzyme-linked immunosorbent assay

Immunoglobulin G (IgG) and albumin from unconcentrated cerebrospinal fluid (CSF) and serum of patients with multiple sclerosis (MS) and non-MS controls were quantitated using enzyme-linked immunosorbent assay (ELISA). The IgG levels, IgG/albumin ratios and IgG indexes were significantly increased in CSF of MS patients compared to those of non-MS controls. The method is sensitive, rapid and reproducible and can be applied to routine laboratory use for quantitation of IgG and albumin in unconcentrated CSF from humans as well as in experimental animals used as models for demyelinating diseases.

Specificity of oligoclonal IgG bands against myelin proteins in chronic relapsing EAE in guinea pigs

We showed previously by using imprint electroimmunofixation that the oligoclonal IgG in sera and CSF from chronic relapsing EAE in guinea pigs were specific to spinal cord and Mycobacterium tuberculosis. We now show that most oligoclonal IgG bands are directed predominantly against isolated myelin basic protein (MBP). Activity to the latter could be removed from sera or CSF by absorption with MBP but not with histone or lysozyme. The oligoclonal IgG reacted weakly with isolated proteolipid apoprotein, and lacked reactivity to myelin-associated glycoprotein. When the oligoclonal IgG activity to myelin proteins was removed from the sera by absorption with a preparation of delipidated myelin before imprint electroimmunofixation, a few bands in some sera still reacted with whole spinal cord homogenate. These results indicate that, in some sera, a part of the oligoclonal IgG was directed against non-myelin proteins or lipids. In contrast to chronic relapsing EAE, CSF oligoclonal IgG from patients with multiple sclerosis showed no reactivity against human brain homogenate, whole myelin, delipidated myelin, and MBP in imprint electroimmunofixation.

Chronic relapsing EAE in guinea pigs: IgG index and oligoclonal bands in cerebrospinal fluid and sera

IgG and albumin levels were quantitated in cerebrospinal fluid (CSF) and sera from chronic relapsing (R)-EAE animals using the enzyme linked immunosorbent assay. The animals showed increased CSF IgG compared to that of age-matched animals injected with complete Freund's adjuvant. However, the CSF IgG index suggested no significant increase in IgG synthesis within the central nervous system of R-EAE animals. Matching CSF and sera from R-EAE animals, when compared in immunofixation after isoelectric focusing, showed identical oligoclonal IgG band patterns. Although the clinical and morphologic findings in R-EAE are similar to those seen in multiple sclerosis, the site of IgG synthesis in these two diseases appears to be different.

Silver staining of unconcentrated cerebrospinal fluid in agarose gel (Panagel) electrophoresis

We subjected cerebrospinal fluid (CSF) from 20 patients with multiple sclerosis and 20 patients with other neurological diseases to agarose gel ( Panagel ) electrophoresis followed by staining with silver. Ten microliters of unconcentrated CSF from multiple sclerosis patients containing 0.4 to 0.8 microgram of immunoglobulin G was found to be optimum for detection of oligoclonal IgG bands, so identified by immunofixation. The band patterns for unconcentrated CSF stained with silver were almost identical to those for the same CSF concentrated 40-fold and stained with Coomassie Brilliant Blue. Silver staining thus enables the clinical laboratory to electrophorese unconcentrated CSF on commercially prepared ( Panagel ) plates.

Silver staining of unconcentrated cerebrospinal fluid in agarose gel (Panagel) electrophoresis

We subjected cerebrospinal fluid (CSF) from 20 patients with multiple sclerosis and 20 patients with other neurological diseases to agarose gel ( Panagel ) electrophoresis followed by staining with silver. Ten microliters of unconcentrated CSF from multiple sclerosis patients containing 0.4 to 0.8 microgram of immunoglobulin G was found to be optimum for detection of oligoclonal IgG bands, so identified by immunofixation. The band patterns for unconcentrated CSF stained with silver were almost identical to those for the same CSF concentrated 40-fold and stained with Coomassie Brilliant Blue. Silver staining thus enables the clinical laboratory to electrophorese unconcentrated CSF on commercially prepared ( Panagel ) plates.

Prevalence of paralytic poliomyelitis in Pondicherry, South India

A community health survey conducted in 16 villages of three blocks of Union Territory of Pondicherry detected lame children affected by poliomyelitis among other problems identified. The survey was conducted from July 1980 to September 1981. The survey method was house-to-house, covering 97% of the houses in the study area. Prevalence of lameness due to poliomyelitis among children aged from 6 to 15 years was 1.6 per thousand. These results were compared with those of the school health survey conducted by the School Health Education Bureau, Pondicherry, for the year 1980-1, which gave an estimate of 0.7 per thousand. The community health examination also confirmed that most of those affected were under 15 and that boys were more vulnerable than girls, as reported by other workers.

Identification of light chain type bands in CSF and serum oligoclonal IgG from patients with multiple sclerosis

The light (L) chain types (kappa and lambda) of oligoclonal IgG bands of matching CSF and serum from 10 MS patients were identified in immunofixation after isoelectric focusing in polyacrylamide gel. Each specimen showed 10-15 oligoclonal bands in pH region of 7.5-9.3. In 7 MS CSF and 5 sera a greater number of oligoclonal IgG bands were of kappa (kappa)-type whereas in 3 CSF and 2 sera the majority was of lambda (lambda)-type. In 3 sera a clearcut correlation of bands with either type of L chain was not observed due to diffuse staining background. Only a small number of oligoclonal IgG bands in 7 of 10 CSF and serum pairs had identical isoelectric points and the same type of L chain. The results show that the individual MS patient had oligoclonal IgG bands in serum, differ with respect to number, isoelectric point and L chain type from the oligoclonal IgG profile seen in the patient's CSF.

A case of monorecidive syphilitic chancre

A 24-year-old man who had been in contact with a woman who had infectious syphilis developed a painless sore on his penis. His general practitioner prescribed tetracycline (250 mg four times a day for seven days). After approximately one month he developed another painless sore at the same site as the previous one. The diagnosis of syphilis was confirmed by dark-field microscopy and serologic tests. Reinfection was thought to be unlikely because he denied having sexual intercourse after the first visit to his general practitioner. Thus, the new lesion was thought to be a case of monorecidive syphilitic chancre.

Unusual bone scan presentation in osteomalacia: symmetrical uptake--a suggestive sign

Osteomalacia presents radiographically as deossification, coarsening of the trabecular pattern, and pseudofractures. Contrary to the usual bone scan manifestation of osteomalacia, consisting of a generalized increase in periarticular radionuclide accumulation and pronounced costochondral junctional uptake, this report describes an unusual bone scan presentation with negative radiographic studies showing only some deossification. Symmetric distribution of the focal lesions is considered a suggestive sign of osteomalacia.