Pagets Disease Pic

The photos show Pagets of the tibia - lower leg - bowing - clinical and Xray

Pagets Disease is a metabolic bone disease that involves bone destruction and regrowth that results in deformity. The patient is frequently entirely assymptomatic and the condition can be discovered after routine Xrays, requested for other reasons. However of those people who become symptomatic, the commonest features are:

Pain
Deformity of bone
Manifestations of complications.
Detail of the thickened and irregular bone structure

In pagets disease, the remodelling process(by osteoclast and osteoblast) is disordered, with large abnormal osteoclasts working at a much greater turnover than normal, followed by the irregular laying down of bone

Treatment:
Gone are the days where pain killers and antiinflammatories were the only approach. The mainstay of therapy at the current state of the art is that of bisphosphonates, either oral or intravenous pulse. Such preperations include - alendronate(oral), risedronate (oral) and pamidronate (intravenous) . Such therapy results in a reduction in the alkaline phosphatase, and reduction in pain.

Axillofemoral bypass graft

This elderly female patient underwent an axillofemoral graft (also called axillofemoral bypass graft) for loss of blood flow in the right femoral artery. The procedure involved connecting the right femoral artery and right axillary artery using an artificial graft tube, which was placed along the subcutaneous plane of the chest and abdomen. This patient underwent Color Doppler imaging to assess the condition and flow in the graft tube. The color Doppler image above shows the artificial axillofemoral graft tube with normal flow through it.
Note the large diameter of the graft tube and location in the subcutaneous plane of the chest wall.