Absolute Risk, 252 Acetabular Dysplasia, 38, 211, 213 Acetabular Protrusion, 38 Achondroplasia, 195, 197, 199–200, 205 Genetic

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Index

absolute risk, 252 angular kyphosis acetabular dysplasia, 38, 211, 213 in Scheuermann’s disease, 45 acetabular protrusion, 38 in tuberculosis, 93–4 achondroplasia, 195, 197, 199–200, 205 ankylosing spondylitis, 57–60, 65 genetic defect in, 199 ankylosis in, 58 skeletal changes in, 200 bamboo spine in, 59 acoustic neuroma, 229–31 erosions in, 59 acromegaly, 78, 207–8 first description, 57 and DISH, 208 HLA B27 58 and, skeletal changes in, 208 operational definition of, 59 acromelia, 198 prevalence of, 58 aDNA sacroiliitis and, 59 in leprosy, 101 skip lesions in, 59 in syphilis, 108 ankylosis, 51 in tuberculosis, 92, 95–6 following fracture, 146 Albers-Schonberg˝ disease, see in ankylosing spondylitis, 58 osteopetrosis in brucellosis, 96 Alstrom syndrome, 78 in DISH, 73 alveolar margin, see periodontal disease in erosive osteoarthritis, 55 amputation, 158–61 in rheumatoid arthritis, 51 indications for, 160–1 in septic arthritis, 89 ancient DNA, see aDNA in tuberculosis, 93–4 anaemia, 136–7 annulus fibrosus, 42–3, 45 cribra obitalia and, 136–7 ante-mortem tooth loss, 238–9 aneurysms, 224–7 and periodontal disease, 238–9 aortic, 224–5 and scurvy, 132 and syphilis, 224 causes of, 238 of vertebral artery, 225–6 anterior longitudinal ligament popliteal, 226 in ankylosing spondylitis, 59 aneurysmal bone cyst, 177 in DISH, 73 angiosarcoma, 182 anti-CCP antibodies, 49, 53

270 index

antra of Highmore, 114 bone remodelling unit (BRU), 18 aorta, 224–5 Bouchard’s nodes, 37 coarctation of, 226–7 brachycephaly, 198, 210 rib notching in, 227 breast cancer, 186–7 apical granuloma, see periapical cavities Brodie’s abscess, 88 apoptosis, 15, 18 brown tumours, 135 arthritis mutilans, 64 Brucella abortus, 96 articular cartilage, 24 brucellosis, 96–7 in osteoarthritis, 27–8 periosteal new bone in, 96 AS, see ankylosing spondylitis spine in, 96 autopsy, 162–4 bunionette, 71 complete, 163 bunions, 70–1 partial, 163 differentiation from gout, 71 signsofintheskeleton,163–4 avascular necrosis, 144–5 calcaneal spur, 62 in Perthes disease, 213 calcitonin, 16 in slipped capital femoral epiphysis, 212 calculus, see dental calculus callus, 13, 148 of femoral head, 145 cancellous bone, 12 of lunate, 145–6 caries, 236–9 of scaphoid, 145 development of, 237 of talus, 146 effects on teeth, 239 caries sicca, 105–6 bamboo spine, 59 case-control (case-referent) studies, 261–3 Bankart lesion, 155 in palaeopathology, 263–4 bare area (within a joint), 25 cement line, 13 Bayes’s theorem, 2, n2 cervical rib, 218–9 Behc¸et’s disease, 225 Charcot joints beheading, 165 in leprosy, 100 bejel, see endemic syphilis in syphilis, 106 bipartite patella, 22 CHD, see congenital hip dsyplasia bladder stones, see kidney and bladder chondroblastoma, 175 stones chondrodermal dysplasia, 202 bone balance, 19 chondroplasia (chondrodysplasia) punctata, bone cysts, 177 202 bone formers (or forming), 30, 72–3 chondrosarcoma, 181 deﬁnition of , 72 chronic recurrent multiple osteomyelitis, 89 bone mass, 17 maximum (or peak), 17 cleft palate, 202 bone matrix, 14 clinodactyly, 198 bone mineral density (BMD), 118–9 cloacae, 85, 93 bone morphogenic proteins (BMP), 18 Cobb angle, 216 bone remodelling, 18 Codman’s triangle, 178 in Paget’s disease, 125 collagen, 14, 42, 132, 148, 200 following fracture, 148 common odds ratio, 254

index 271

compact bone, 12 diastematomyelia, 232–3 comparative data, 7–9 diet, 10, n26 qualitative, 8 diffuse idiopathic skeletal hyperostosis, see confidence intervals, 252, n6 DISH congenital hip dysplasia, 38, 211 discitis, 88 cortical defects, 22 DISH, 73–77 coxa valga and acromegaly, 208 in poliomyelitis, 109 and diabetes, 74 coxa vara and osteoarthritis, 31 in congenital hip dysplasia, 211 and the monastic way of life, 75 and sacroiliac joints, 74 craniosynostosis, 198, 209 and spondylolisthesis, 153 cranio-tabes, 129 anterior longitudinal ligament (ALL) in, crepitus, 33 73 cribra orbitalia, 116, 136–7 early DISH (eDISH), 77 Crohn’s disease, 65 cytokines in, 74 cross-sectional studies, 252 enthesophytes in, 72 crystal arthropathy first description of, 73 of the shoulder, 36 operational definition of, 77 cup and pencil sign, 64 prevalence of, 74 cytokines, 14–15 posterior longitudinal ligament in, 77 and inflammations, 20 dislocations, 155–6 in bone remodelling, 18–19 definition of, 138 in DISH, 74 of shoulder, 155 in erosive osteoarthritis, 54 DMFT index, 265–6 in healing fractures, 147–8 dwarfism, 195–206 in heterotopic ossification, 80 and zinc deficiency, 206 in leprosy, 99 definition of, 195 in osteoarthritis, 27 pituitary, 196 in psoriatic arthropathy, 62 scheme for differentiating, 206 in rheumatoid arthritis, 48, 51 dyschondrosteosis, 204–5 in tuberculosis, 91 and Madelung deformity, 203 skeletal changes in, 204 DCO, see dyschondrosteosis dental abscess, see periapical abscess facies leprosa,see rhino-maxillary syndrome dental calculus, 240–1 fibrodysplasia ossificans progressiva, 80–1 recognition of, 201 fibrosarcoma, 181 dental cysts, 247–7 fibrous dysplasia, 213–4 dental enamel, 243–4 types of, 214 defects of, 244 final achieved height, 192–3 dentogenesis imperfecta, 200 flame sign, 125 diabetes, 74, 89, 136 fluorosis, 245 diagnosis, 2–7 follow-up studies, 250 accuracy of, 3–4 FOP, see fibrodysplasia ossificans of osteoarthritis, 4–5 progressiva

272 index

Forestier’s disease, 73, 76 haemangioma, 176 fractures, 138–51 hallux rigidus, 39 aetiology of, 150–1 hallux valgus, 71 and osteogenesis imperfecta, 201 hanging, 165–7 and osteoporosis, 203 effects on the skeleton, 166–7 and peripheral nerve damage, 146–7 hangman’s fracture, 166 Hansen’s bacillus, see Mycobacterium leprae classification of, 139 Haversian system, 13, 116 complications of, 143–7 health, 9–10 compound and osteomyelitis, 87 Heberden’s nodes, 37 consequences of, 141–2 hereditary multiple exostoses (HME), definition of, 138 202–3, 205 epidemiology of, 149–50 genetic defect in, 202 eponymous, 140–1 heterotopic ossification, 79–82 healing of, 147–7 and osteochondroma, 175 cytokines in, 147 causes of, 79 factors affecting, 148 cytokines and, 80 stress, see stress fractures Hill-Sachs lesion, 155 timing of, 148 HFI, see hyperostosis frontalis interna treatment of, 142–3 HLA B27 fungal infections of bone, 111 and ankylosing spondylitis, 58 and enteropathic arthropathy, 65 gall stones, 233–4 and psoriatic arthropathy, 63 composition of, 233 and reactive arthropathy, 60 Ghon focus, 91 and spondylarthritides, 56 gigantism, 207–8 HLA DR4, 48 IGF (somatomedin), 207 Hodgkin’s disease, 182–3 gout, 67–70 Howship’s lacunae, 16 acute, 68 Hutchinson’s teeth, 108 common sites of, 68 hydroxyapatite, 14 chronic, 68 hyperostosis cranii, 78 differentiation from bunions, 71 hyperostosis frontalis interna, 78–9 erosions in, 68 and acromegaly, 78 Martel hook sign in, 68–9 and Paget’s disease, 78 operational definition of, 69 first description of, 78 tophi in, 68 hyperparathyroidism, 134–5 uric acid metabolism in, 67–8 bone resorption in, 134–5 growth, 191–5 tuftal resorption in, 135 rates, 193–5 hydatid disease, 111–2 spurts, 191 growth hormone impingement syndrome, 41 in DISH, 74 operational definition of, 42 in gigantism, 207 incidence, 249, 250–2 in pituitary dwarfism, 196 inflammation, 20 gull-wing sign, 55 interleukins (IL), 15 gun-shot wounds, 157–8 and osteoarthritis, 27

index 273

insulin-like growth factors (IGF), 18 Charcot joints in, 100 interstitial bone, 13 clinical types, 98–9 intervertebral disc, 62 cytokines in, 99 intervertebral disc disease, 42–5 lepromatous, 99 neurological complications of, 44–5 licked candy sign in, 100 operational definition of, 43 operational definition, 101 intervertebral foramen, 44, 225 rhino-maxillary syndrome in, 100–1 widening of, 225 tuberculoid, 99 IVD, see intervertebral disc disease Leri-Weill´ disease, see dyschondrosteosis IVF, see intervertebral foramen leukaemia, 183 involucrum, 85 licked candy sign, 100 iron deficiency anaemia, 136–7 ligamentum flavum ossification of, 81 joint space, 24 lining cells, 14 narrowing in osteoarthritis, 33 London Bills of Mortality, 90, 128 joints Looser’s zones, 130 synovial, 24–6 lung cancer, 187–8 types of, 24 lymphomas, 182–3 juvenile arthritis, 66–7 prevalence of, 66 McCune-Albright syndrome, 214 psoriasis and, 66 macrocephaly, 208–9 rheumatoid factor in, 66 Madelung deformity, 203, 204, 205 Maffucci’s syndrome, 174 Kashin-Beck disease, 31, n31 marginal osteophytes keeled acromion, 41 in intervertebral disc disease, 43, 44 kidney and bladder stones, 234–5 in osteoarthritis, 33 composition of, 234 Martel hook, 68 kidney cancer, 138 matching, 263 Klippel-Feil syndrome, 215, 218 maximum bone mass (MBM), 17, 118 kyphosis, 215 meningioma, 227–9 in ankylosing spondylitis, 59 diagnosis of, 228 in fibrous dysplasia, 214 prevalence, 229 in Scheuermann’s disease, 45 skull changes in, 227–8 in tuberculosis, 94 mesomelia, 198 metallo-enzymes, 27 Launois’s deformity, 62 metastatic bone tumours, 184–90 lamellar bone, 13 microcephaly, 208 Langer dwarfism, 205 micromelia, 198 Legg-Calve-Perthes´ disease, see Perthes Milkman’s syndrome, 130 disease missing data, 256–7 leprosy, 89, 97–101 monks aDNA and, 101 and DISH, 74 and psoriatic arthropathy, 98 dietary allowance of, 76 and rheumatoid arthritis, 98 Moon’s molars, 108 and syphilis, 98 Morgagni-Stewart-Morel disease, 78 bone changes in, 100–1 morphological variation of teeth, 245–6

274 index

mulberry molars, 108 osteitis fibrosa cystica, 135 mummies, 10–11 osteoarthritis, 26–40 Mycobacterium bovis, 90 aetiological model, 29 Mycobacterium leprae, 98 and congenital hip dysplasia, 211 Mycobacterium tuberculosis, 90 and Madelung deformity, 205 mycolic acids, 96 and occupation, 29 myeloma protein, 184 and osteochondritis dissecans, 154 myelomatosis, 183–4 and Paget’s disease, 39 RANK-L/OPG in, 184 and Perthes disease, 213 myositis ossificans, see heterotopic articular cartilage in, 27 ossification atrophic, 30 cytokines and, 27 neurofibromatosis, 213–2 diagnosis of, 33–4 skeletal changes in, 231 erosive, 53–6 types of, 231 evolutionary theory of, 33 non-metric traits, 23 following trauma, 30, 146 nucleus pulposus, 42–3, 45 generalised, criteria for, 31 genetic factors, 28 OA, see osteoarthritis grooving or scoring on joint surface, 28, OCD, see osteochondritis dissecans 32 odds ratio, 262 hypertrophic, 30 odontogenic carcinomas, 247 joint changes in, 27–8 odontoid peg monoarticular, 30 erosions in rheumatoid arthritis, 50 natural history of, 30–33 odontomas, 246–7 of acromio-clavicular joint, 31, 35 OI, see osteogenesis imperfecta of ankle, 33, 38 Ollier’s disease, 174 of costo-transverse joints, 36, 216 operational definition, 6–7 of elbow, 33, 36 of ankylosing spondylitis, 59 of foot, 38–9 of DISH, 77 of hand, 31, 37 of erosive osteoarthritis, 55 obesity and, 29 of gout, 69 of hip, 31, 38 of impingement syndrome, 42 obesity and, 29 of intervertebral disc disease, 43 of knee, 31, 37 of leprosy, 101 obesity and, 29 of osteoarthritis, 34 of shoulder, 36 of Paget’s disease, 126 of spine, 31, 35–5 of psoriatic arthropathy, 64 of sterno-clavicular joint, 35 of reactive arthropathy, 61 of temporo-mandibular joint, 34–5 of rheumatoid arthritis, 52 of wrist and carpal bones, 36 of rickets, 129 operational definition of, 34 of rotator cuff disease, 42 polyarticular, 30 of scurvy, 132 precipitants of, 28–30 of syphilis, 108 secondary of tuberculosis, 95 stages of, 27

index 275

symptoms of, 33 osteonecrosis, see avascular necrosis in relation to morphology, 31 osteopaenia, 119 osteoblastoma, 173–4 osteopetrosis, 203–4 osteoblasts, 15, 18 and rickets, 203 and osteosarcoma, 179 bone changes in, 203 and secondary bone tumours, 186 fractures and, 203 osteochondritis dissecans (OCD), 154–5 osteoporosis, 118–22 and osteoarthritis, 154 and ankylosing spondylitis, 58 sites affected, 154 and osteoarthritis, 39–40 osteochondroma, 175–6 and osteogenesis imperfecta, 201 and heterotopic ossification, 175 bone mineral density in, 118–9 osteoclasts, 16, 18, 135 circumspecta, 126 and secondary bone tumours, 186 cortical thinning in, 121 in Paget’s disease, 124 established, 119 osteocytes, 16–17 fractures and, 118 osteoid, 15 kyphosis in, 215 in osteomalacia, 130 Singh index, 121–2 in rickets, 127 palaeopathological diagnosis of, 120–2 osteoid osteoma, 172–3 potentiating factors, 119–20 osteogenesis imperfecta, 200–1 primary, 119 collagen genes in, 200 secondary, 119 teeth in, 200 t-scores in, 119 types of, 200–1 z-scores in, 119 osteomalacia, 130 osteosarcoma, 178–81 Looser’s zones in, 130 common sites of, 179 osteoid in, 130 in Paget’s disease, 127, 180 periosteal new bone in, 130 radiographic signs in, 179–80 pseudo-fractures in, 130 outcome variables, 255–6 osteomas, 171–2 and diving, 172 Paget’s disease, 122–7, 168 osteomyelitis, 83–89 aetiological model, 125 and leprosy, 100 and congenital syphilis, 107 Brodie’s abscess and, 88–9 and HFI, 78 chronic recurrent multifocal, 89 and meningioma, 228 cloacae in, 85 and osteoarthritis, 39 complicating compound fractures, 87 and osteosarcoma, 180 discitis and, 88 bone remodelling in, 125 infectious agents in, 84–5 bony changes in, 125–6 involucrum in, 85 complications of, 126–7 periosteal new bone and, 85 first description, 122 phossy jaw, 88 flame sign in, 125 septic arthritis and, 89 genetic susceptibility in, 124 sequestra in, 86 operational definition of, 126 Staphylococcus aureus and, 84–5 osteoclasts in, 124 vertebral, 88 osteosarcoma in, 127, 180

276 index

Paget’s disease (cont.) poliomyelitis, 109–10 pathological fractures in, 127 effects on the skeleton, 109 prevalence, 123 polydactyly, 198 stages of, 125 popliteal artery aneurysm, 226 Pancoast tumour, 188 posterior longitudinal ligament (PLL), 77 pannus, 50 cytokines and, 77 parasitic disease of bone, 111–14 ossification of, 77 parathyroid hormone (PTH), 15, 16, 134 Pott’s disease, 94 pathognomonic signs, 6 prevalence, 249, 252–5 of DISH, 77 crude, 254 of osteomyelitis, 86 overall, 257–8 pathological fractures, 127 period, 253 Pelkan’s sign, 132 point, 253 periapical cavities, 241–3 primary bone, 13 differentiation of, 242–3 primary osteons, 13 types of, 242 proportional mortality (or morbidity) ratio, periodontal disease, 239–40 259–61 alveolar margin and, 240 prostate cancer, 188 causes of, 239 PsA, see psoriatic arthropathy recognition of, 240 pseudoarthrosis, 143 types of, 240 in congenital hip dysplasia, 211 periosteal chondroma, 174 pseudo-erosions, 52 periosteal new bone (PNB), 20, 21, 115–7 pseudo-pathology, 21–2 and malignant tumours, 178 psoas abscess, 93 in brucellosis, 96 psoriasis, 62, 66 in osteomyelitis, 85 psoriatic arthropathy, 62–5, 68 in reactive arthropathy, 62 cup and pencil sign, 64 in scurvy, 132–3 cytokines in, 62 in syphilis, 105 erosions in, 64 major causes of, 116 HLA B27, 63 and, of ribs in tuberculosis, 94–5, 117 operational definition of, 64 periosteal tumours, 174, 180 sacro-iliac joints in, 64 periosteum, 12, 19, 20, 25, 116, 126 skip lesions in, 65 structure of, 20 spinal fusion in, 64–5 periostitis, see periosteal new bone sub-sets of, 63 Perthes disease, 38, 212–3 stages of, 213 qualitative data, 8 phossy jaw, 88 pinta, 102 RA, see rheumatoid arthritis pituitary dwarfism, 196–7 rachitic rosary, 129 pituitary fossa RANK, 16 in dwarfism, 196 ranking, 258–9 in gigantism, 207 RANK-L, 16 volume of, 207 and myelomatosis, 184 PMR, see proportional mortality ratio and secondary tumours, 185

index 277

ReA, see reactive arthropathy bony changes in, 41 reactive arthropathy, 60–3 operational definition, 43 aetiological model, 62 rugger-jersey appearance, 203 first description, 60 HLA B27, 60 and, sabre tibia, 105, 107 operational definition, 61 sacro-iliac joint prevalence of, 61 in ankylosing spondylitis, 58 sacro-iliac joints in, 61 in DISH, 74 skip lesions in, 61 in reactive arthropathy, 61 Reiter’s syndrome, see reactive in rheumatoid arthritis, 51 arthropathy in sero-negative arthritides, 53, 56 relative risk, 251–2 saw-tooth sign, 55 remodelling, 17–19 scaphocephaly, 198, 210 cytokines and, 18–19 SCFE, see slipped capital femoral epiphysis rheumatoid arthritis, 46–53, 98 Schmorl’s nodes, 45 aetiological model of, 50 and Scheuermann’s disease, 45 cytokines in, 51 Scheuermann’s disease, 45 erosions in, 50 sclerosis, 33, 52, 68 of odontoid peg, 50 and erosions, 52 first description, 46 in gout, 68 HLA DR4, 48 and, in Paget’s disease, 126 natural history of, 49–51 scoliosis, 215–8 operational definition, 52 and Klippel-Feil disease, 215 rheumatoid factor in, 48 measurement of, 216 sacro-iliac joint in, 51 prevalence, 217 spinal fusion in, 51 types of, 215 ulnar deviation of fingers in, 51 scrofula, 92 rheumatoid factor, 9, 48, 53 scurvy, 130–3 in juvenile arthritis, 66 collagen synthesis in, 131 in rheumatoid arthritis, 48 differentiation from rickets, 131 rhino-maxillary syndrome, 100–1 James Lind and, 131 rhizomelia, 198 operational definition, 132 rickets, 127–9 periosteal new bone in, 132–3 and malabsorption, 129 radiological signs, 131 and osteopetrosis, 203 sudden death in, 132 and pneumonia, 129 vitamin C in, 130–1 bony changes in, 129 secondary bone, 13 deformation of pelvis in, 128 secondary osteons, 13 healed, 129 septal aperture, 22 metaphyseal changes in, 129 septic arthritis, 89 operational definition, 129 sequestrum, 86 vitamin D and, 127 sero-negative, 9, 48 risk ratio, see relative risk arthropathy, 53–66 rotator cuff disease, 36, 40–42 Sharpey’s fibres, 19, 20, 116 and keeled acromion, 41 shepherd’s crook deformity, 214

278 index

sickle cell disease, 136 striae of Retzius, 244 simple (unicameral) bone cysts, 177 subchondral bone, 24 Singh index, 121–2 subchondral cysts, 27 sinusitis, 114–5 subluxation, 155 situs inversus, 73 definition of, 138–9 six lumbar vertebra, 219–20 in rheumatoid arthritis, 51 skeletal dysplasias, 198–0 in reactive arthropathy, 62 skip lesions, 61 supra-condylar process, 22 in ankylosing spondylitis, 59 syndactyly, 198 in reactive arthropathy, 61 syndesmophytes, 65 in psoriatic arthropathy, 65 synovial joint skull growth, disturbances of, 208–9 structure of, 24 skull thickening synovial fluid, 25 in haemolytic anaemias, 137 synovial membrane, 25 in HFI, 78 in rheumatoid arthritis, 49–50 in Paget’s disease, 126 structure of, 25 slipped capital femoral epiphysis, 38, 211–2 syphilis, 102–8 smallpox, 110–11 aDNA and, 108 risks to archaeologists from, 110, n118 and aortic aneurysm, 224 SpA, see spondylarthritides bony changes in, 105–6 spina bifida occulata, 219, 232 caries sicca in, 105–6 spina ventosa, 94 congenital, 102, 106–7 spinal dysraphism, 232 changes in the teeth in, 108 spinal fusion differentiation from Paget’s disease, 107 in ankylosing spondylitis, 58 mercury treatment, 102–3 in DISH, 73, 76 operational definition, 108 in psoriatic arthropathy, 64–5 origins of, 104–5 in reactive arthropathy, 62 periosteal new bone in, 105 in rheumatoid arthritis, 51 sabre tibia in, 105, 107 in sero-negative arthropathy, 53, 56 stages of, 103 spondyloarthritides (spondyloarthropathy), 53, 56–7 thalassaemia, 136 see also, sero-negative arthropathy thyroid cancer, 188–9 and HLA B27, 56 thyroid disease, 184 sacro-iliac joints in, 53 tide mark, 24 spinal fusion in, 53 tophi spondylolisthesis, 153 in gout, 68 and DISH, 153 transitional vertebrae, 219 spondylolysis, 151–3 trepanation, see trephination prevalence, 153 trephination, 161–2 Staphylococcus aureus, 84, 87–9 Treponema pallidum, 102 sternal aperture, 22 treponemal disease, see syphilis Still’s disease, 66 Trummerfeld˝ zone, 133 stones, see gallstones and kidney stones tuberculosis, 90–7 stress fractures, 151–4 aDNA in, 92 stress markers, 116 ankylosis in, 93–5

index 279

bony changes in, 93–5 tumours of teeth, 246–7 bovine form, 92 Turner’s syndrome, 195, 197, 205 cytokines in, 91 types of bone, 12–13 differentiation from brucellosis, 96 evolution of, 92–3 ulcerative colitis extra-spinal, 94–5 and enteropathic arthropathy, 65 human form, 90–2 undifferentiated spondylarthritides, 66 modes of infection, 90, 92 uric acid mycolic acids and, 96 in DISH, 74 of joints, 94 metabolism, in gout, 67 operational definition, 95 periosteal new bone on ribs, 94–5, valgus 117 definition of, 7, n100 tumour necrosis factor (TNF), 15, 18 varicose veins, 116 and osteoarthritis, 27 varus tumours of bone definition of, 7, n100 benign, 170–7 venereal syphilis, see syphilis definition of, 168 venous plexus of Batson, 188 common sites of, 171 vertebral artery, 224 epidemiology of, 168–70 aneurysm of, 225–6 malignant, 177–84 tortuosity of, 225 definition of, 168 vitamin A, 74 metatastic, 184–9 vitamin C, 130–1 appearances of, 185–6 vitamin D, 16, 119, 130 common sites, 185 metabolism of, 127 diagnosis of, 189–90 Volkmann canals, 13 from breast cancer, 186–7 from kidney cancer, 188 white line of Fraenkel, 132 from lung cancer, 187–8 Wimberger’s line, 132 from prostate cancer, 188 Wollf ’s Law, 19 from thyroid cancer, 188–9 Wormian bones, 190, 201 mode of spread, 184–5 wounding, 156–8 primary ‘wrong-end’ reasoning, 79 definition of, 168 secondary, see also metastatic tumours yaws, 103 definition of, 168 diagnosis of, 190 zinc deficiency, 206