A Colour Atlas of Bone Disease (Wolfe medical atlases) by Victor Parsons

By Victor Parsons

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Sample text

Sir James Paget's classic description of the advanced generalised bone disease that bears his name has never been bettered: 'It begins in middle age or later, is very slow in progress, may continue for many years without influence on the general health, and may give no other trouble than those which are due to the changes of shape, size, and direction of the diseased bones. Even when the skull is hugely thickened and all its bones exceedingly altered in structure, the mind remains unaffected. The disease affects most frequently 48 the long bones of the lower extremities and the skull, and is usually symmetrical.

The muscle weakness and characteristic gait frequently present could be due to depressed plasma calcium levels or vitamin 0 deficiency, both of which are related to contractability of muscle. Radiographic features of osteomalacia include diminished bone density, loss of bone detail and the presence of Looser's zones which represent bands of unmineralised callus (osteoid), a result of small stress fractures and minor injuries. Arteriograms show Looser's zones in the upper shaft of the femur and in the pubic ramus occurring near vascular entry sites (123 and 124).

The microscopic appearances are variable, but include new bone deposition and plump osteoblasts which are uniform in appearance and lack the pleomorphism, hyperchromatism and mitotic activity seen in osteosarcoma (197 and 198 demineralised sections, H&E x 150 and x 80). 197 Osteoblastoma 198 Osteoblastoma 61 199 O~teoblastoma of maxilla The X-ray picture is not distinctive but shows a well-circumscribed neoplasm expanding the bone and usually limited by a shell of cortical new bone. A soft tissue shadow may be present (199).

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