Bones in the Schrank
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INTRODUCTION
Underwear Boxers Briefs Undershirts Swimwear. In the intrusion model 10 — 12 , a defect occurs in the articular cartilage and joint fluid passes through the breached cartilage, resulting in hydraulic destruction of the subchondral bone 4 , 5.
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The contusion model finds repetitive microtrauma as the principal etiology leading to a localized area of subchondral necrosis and secondary cyst formation 11 — In line with the contusion model, McLaren et al. Our observation of several cysts containing areas of fat necrosis supports this hypothesis. In these reports, the wall of the cyst consists of fibrous, collagenous fibers similar to fattened histiocytes, and partly mucoid-degeneration without epithelial cells and synovial lining 1 , 4. Intraosseous ganglion cysts were reported to occur predominantly in young and middle-aged adults 3 , Alternatively, Schrank et al.
According to Schrank et al. On the contrary, degenerative cysts were commonly located in the subchondral region with direct connection to the joint. Diagnosis of intraosseous ganglion cyst is important as some symptomatic cysts require surgical treatment with curettage.
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However, distinguishing imaging and histologic features between an intraosseous ganglion cyst and a cyst arising through a degenerative process have not been fully established. Several of the cysts observed in our series had the typical features of degenerative cysts in that they were located in the subchondral bone with overlying cartilage degeneration and direct communication with joint cavity. However, three cysts in our sample were subcortically located and separated from the articular surface.
None of our cysts displayed a true synovial lining, a feature that was previously thought to be diagnostic of degenerative cysts. Two cysts in our study were adjacent to attachment sites of inter-carpal ligaments, a feature thought to be more characteristic of intraosseous ganglion cysts. Our study has several limitations.
First, the number of specimens studied was limited; however, the absence of a synovial covering was documented in all of the specimens. Second, the specimens were frozen and thawed, which may have influenced the signal intensities of the lesions in the MR images.
The processing of the specimen may also have resulted in loss of internal cyst contents. Third, MR images and anatomic slices were analyzed concurrently, and this may have caused bias in assessing the detectability of cysts, which were of low intensity or not well seen owing to their fibrous content.
In conclusion, MRI, gross pathology and histology correlation in our study suggests that intracarpal bone cysts that are found in degenerative wrists are common and often subcortical or subchondral, reflecting a spectrum of fatty necrosis and fibrocystic change. Inflammation and vascularity are absent. These cysts are typically surrounded by fibrous walls without a true synovial lining and are frequently in close proximity to degenerated tissue such as cartilage or ligaments.
Bones in the Schrank (Hardcover)
Degenerative intracarpal cysts are far more common than the previously reported intraosseous ganglion cysts. However, the two share multiple overlapping imaging and histologic features. The diagnosis of a true intraosseous ganglion cyst should be reserved for younger patients who are clinically symptomatic, with lesions that are metabolically active, or clearly connecting with a soft-tissue ganglion cyst.
Male cadaver; age at death, 85 years. Fat-saturated proton density-weighted axial image of the wrist a showing cysts located beneath the cartilage of distal radioulnar joint arrow , with a photograph of the cut surface b. Histology c shows degeneration of cartilage with irregularities on the surface arrow and a separation in the tidemark arrowhead. Conflict of interest disclosure. National Center for Biotechnology Information , U. Journal List Diagn Interv Radiol v.
Published online Aug Trudell , and Donald L. Author information Article notes Copyright and License information Disclaimer. From the Department of Radiology H.
Bones in the Schrank - Joyce Holland - Google Книги
Received Jun 5; Accepted Jun 9. This article has been cited by other articles in PMC. Schrank also endorses the benefits of "hand rails rather than a towel bar that will pull off the wall when you grab it to stop a fall. His two most obvious victims are his former close collaborator, the British musician and lyricist Ivan Schrank Rhys Ifans , and his brother's PA, the kindly, vulnerable Florence Greta Gerwig.
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