Biomedical subjects
A B Goldman
Publications and source records attributed to A B Goldman.
Localized infectious and neuropathic diseases.
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Haemophilic arthropathy in the joints of the hands and feet.
Radiographs of the hands and feet of 72 haemophilic patients were reviewed for peripheral joint involvement. Fifty patients or 69% had changes in the small joints of their hands and/or feet with a total of 160 abnormal joints. In the hands the metacarpo-phalangeal joints were predominantly involved (42 of 50 joints), and in the feet, the metatarso-phalangeal joints (68 of 110 abnormal joints), as well as the posterior subtalar joint (36 of 110 joints). Röntgen abnormalities were characterized by irregularity and/or flattening of the articular cortices. The involvement of the small peripheral joint in haemophilic patients has not been a primary consideration in previous clinical and radiographic studies because of the more common and more debilitating changes in the large joints. The recognition of involvement of the small joints is described to avoid misinterpretation of the röntgen findings and to appreciate the incidence of involvement, especially with the increased availability of replacement therapy.
Slipped capital femoral epiphyses complicating renal osteodystrophy: a report of three cases.
Three adolescents with bilateral slipped capital femoral epiphyses complicating renal disease are presented. In one case, the severity of the deformities necessitated total hip replacement. Pathological specimens were available for evaluation. In all 3 cases, epiphysiolysis was accompanied by severe subperiosteal reabsorption along the medial aspect of the femoral neck, widening of the cartilaginous growth plate, and coxa vara. The radiographic diagnosis of a minimally displaced femoral epiphysis may precede the clinical symptoms. Early recognition of this complication is important, since the treatment of choice is prophylactic surgical stabilization before disabling deformities occur.
The double-contrast shoulder arthrogram. A review of 158 studies.
Experience with double-contrast arthrography indicates it is superior to the single-contrast technique. First, the double-contrast study provides additional information on the width of rotator cuff tears and on degeneration in the tendons. This information is valuable in choosing surgical candidates and electing the best surgical incision. Second, the air-distended capsule permits visualization of the entire intra-articular portion of the biceps tendon. Third, improved visualization of the articular cartilages is important in evaluating patients with previous anterior shoulder dislocations or inflammatory arthritis.
Neuropathic injuries to the lower extremities in children.
Neuropathic injuries of the lower extremities in children due to meningomyelocele, congenital indifference to pain, and peripheral nerve damage were studied in 10 patients. The injuries fell into four categories: (a) fractures of the metaphysis and diaphysis of long bones, (b) epiphyseal separation, (c) Charcot joints, and (d) soft-tissue ulceration. These injuries are often unrecognized; untreated, they can lead to severe disability. For patients with impaired sensation, radiographs should be obtained at any sign of localized soft-tissue swelling, warmth, or hyperemia, especially near a joint. Following diagnosis, immobilization of the limb will lead to prompt healing of fractures and epiphyseal separation.
Acute chondrolysis complicating slipped capital femoral epiphysis.
Radiographs of 20 patients with acute chondrolysis complicating a slipped capital femoral epiphysis were reviewed with emphasis on the radiographic features and differential diagnosis. There was bilateral disease in five instances; radiographic follow-up ranged from 6 months to 5 years. The onset of chondrolysis occurred after surgery in 18 of the 25 abnormal hips. Acute necrosis of the articular cartilage is characterized radiographically by (1) persistent juxtaarticular osteoporosis; (2) progressive narrowing of all or a portion of the cartilage space; and (3) erosion of the subchondral cortices of the femoral head and acetabulum. The radiographic differential diagnosis varies with the stage of disease. The initial osteoporosis is indistinguishable from disuse. The rapid loss of the joint space, accompanied by destruction of the central portions of the subchondral bone, makes differentiation from postoperative infection a common problem. Late changes may resemble either degenerative joint disease or a chronic inflammatory arthritis. The accurate diagnosis of acute chondrolysis depends on correlation of the clinical history and radiographic findings.
Discogenic vertebral sclerosis.
Narrowing of a disc space, sclerosis of the adjacent vertebral bodies, and irregularity of the vertebral end plates constitute a roentgen complex classically associated with infectious spondylitis. However, narrowing of a disc space may be the result of a herniated nucleus pulposus, and in some individuals the reactive sclerosis is sufficiently intense to resemble infection. Roentgenographic recognition of discogenic vertebral sclerosis may obviate the need for further evaluation and biopsy. Forty-four cases of discogenic vertebral sclerosis, nine with surgical proof and four developing after disc surgery, are presented. Roentgen signs helping to distinguish it from infection include: (i) rounded sclerosis most frequently in the anterior vertebral body (100%), (ii) central lucency in the sclerosis (77%), (iii) associated degenerative changes at the intervertebral disc, e.g. vacuum phenomena (44%), (iv) absence of a para-spinal mass and (v) maintenance of vertebral body height.
Proximal focal femoral deficiency.
The term proximal focal femoral deficiency (PFFD) is applied to a spectrum of conditions characterized by partial absence and shortening of the proximal femora and thought to result from an early disturbance of growing mesenchyme. The mildest cases, Classes A and B, exhibit a relatively normal acetabulum and capital femoral epiphysis, despite the dysplastic shaft. There may be a subtrochanteric varus deformity or a pseudoarthrosis accompanying the shortening of the femoral shaft. At the opposite end of the spectrum, the most severely deformed cases, Classes C and D, have involvement of the acetabulum, and the entire proximal femur. In cases of advanced dysgenesis, the findings include: a stunted severely shortened femur with a club-shaped or pointed proximal end, an iliac projection just above the anatomic site of the acetabulum, a spherical obturator foramen, and squaring of the iliac crest. Twenty-one patients (2 bilateral) with proximal focal femoral deficiency are presented (23 femurs). Differentiation of proximal focal femoral deficiency from other congenital and acquired deformities of the hip joint is essential for selecting the proper treatment.
The double contrast shoulder arthrogram: evaluation of rotary cuff tears.
Double contrast shoulder arthrograms revealed rotator cuff abnormalities in 14 of 31 cases. Although both the single and double contrast methods provide a means of diagnosing complete tears of the cuff, or partial tears of its inferior surface, the double contrast study provides additional information regarding the width of the tear, the presence of degenerative changes in the cuff, and the condition of the articular cartilages.
Macrodystrophia lipomatosa: radiographic diagnosis.
Macrodystrophia lipomatosa is a rare form of localized gigantism characterized by progressive overgrowth of all the mesenchymal elements with a disaproportionate increase in the fibroadipose tissues. This congenital abnormality occurs most frequently in the distribution of the median nerve in the upper extremity and in the distribution of the planter nerves in the lower extremity. It is usually recognized at birth or in the neonatal period. As the patient grows, the deformity begins to mechanically interfere with joint function, vascular supply, and innervation. Six cases are described with emphasis on the radiographic findings which differentiate this entity from other forms of local gigantism. These findings include a predominately distal involvement, enlargement of the phalanges and soft tissue elements of the digit, and lucencies within the soft tissues.
Osteitis deformans of the hip joint.
It is estimated that 66% of patients with Paget's disease have involvement of the pelvis and 46% of the proximal femur. Therefore, it is not unexpected that hip pain is one of the major presenting complaints. Analysis of the radiographs of 25 hips with one or more articular sufaces involved by Paget's disease demonstrated narrowing in 24. Unlike the findings in primary degenerative joint disease, the majority of cases had a radiographic pattern characterized by uniform narrowing of the articular cartilage and minimal hypertrophic changes. Pathologic correlation was obtained from specimens of four patients who underwent total hip replacements. The pathogenesis of arthritic changes associated with osteitis deformans is not established. The evidence presented suggest that cartilagenous narrowing results from a disturbance in endochondral bone formation related to the hyperemia of Paget's disease. Secondary deformities of bone produce further derangement of joint mechanics. The secondary degenerative changes which ensue differ mechanically, and therefore radiographically, from primary degenerative joint disease.
Radiologic diagnosis of loosening and infection in hip prostheses.
Unexplained pain following prosthetic replacement of the hip should be evaluated by a review of serial plain radiographs, hip aspiration and arthrography. The distinction between infection and loosening cannot be established on plain films. The preoperative diagnosis of infection and/or loosening should be attempted by hip aspiration and arthrography. Neither of the latter studies is definitive but in combination they correlate well with the surgical findings.
Osteochondritis dissecans complicating Legg-Perthes disease. A report of four cases.
Osteochondritis dissecans of the femoral head occurs as a rare complication in the late onset of Legg-Perthes disease. The etiology of this complication is uncertain. Theories include: (a) persistence of an ununited fragment and (b) fragmentation of the femoral head weakened by revascularization accompanying healing. The area of osteochondritis dissecans may not be readily apparent on routine radiographs and a high index of suspicion is necessary for diagnosis. Four cases of osteochondritis dissecans of the hip presenting 6--18 years after the diagnosis of Legg-Perthes disease are described. Three patients were studied by arthrography, and the findings correlated well with symptomatology.
Myositis ossificans circumscripta: a benign lesion with a malignant differential diagnosis.
Localized areas of active myositis ossificans, occurring without a clear history of antecedent trauma, have been referred to as a "pseudo-malignant osseous tumor of soft tissue." This lesion may be mistaken both roentgenographically and pathologically for a malignancy. The roentgenographic signs which favor a diagnosis of non-neoplastic heterotopic bone formation include a lucent zone between the lesion and the adjacent bone, an intact underlying cortex, diaphyseal location, dense calcification in the periphery, and loss of volume on serial films.
Posttraumatic adhesive capsulitis of the ankle: arthrographic diagnosis.
A disabling decrease in range of motion may be a sequelae of ankle trauma. This complication can result from secondary degenerative joint disease, osteochondrial fractures with loose bodies, or posttraumatic adhesive capsulitis. The latter entity is well recognized as a complication of shoulder injuries but is rarely described in other joints. Since adhesive capsulitis produces no specific plain film findings, the confirmation of this diagnosis depends on the usage of a contrast study. It is only recently that ankle arthrography has been utilized to differentiate between the various causes of a painful posttraumatic ankle. Once a diagnosis is established by arthrography, therapeutic efforts can be directed toward relieving the specific abnormality. Three cases of "frozen" ankles are presented. Two were the result of intracapsular fractures, while the third had previously sustained a severe injury of the soft tissue. The arthrographic findings included a decrease in the joint capacity, obliteration of the normal anterior and posterior recesses, and extravasation of contrast material along the needle track.
Radionuclide uptake studies of bone: a quantitative method of evaluating the response of patients with Paget's disease to diphosphonate therapy.
In order to evaluate and quantitate the therapeutic efficacy of disodium etridonate (EHDP) in the treatment of Paget's disease, a prospective double-blind study was instituted. Subjects received either placebo, low-dose EHDP, or high-dose EHDP and were evaluated prior to therapy and 6 months later. Bone scans were performed with 99mTc or 18F and radioisotopic uptake studies were conducted. The results were correlated with clinical improvement, biochemical parameters, and radiographic skeletal surveys, and indicate that the radioisotopic uptake studies are both a sensitive and reproducible means of evaluating the degree of response to EHDP.
Bone scanning-osteogenic sarcoma. Correlation with surgical pathology.
This study was designed to evaluate the role of isotopic scanning in determining the local extension of osteosarcoma. During the period of the study, 13 patients wtih biopsy proven osteosarcomas were evaluated. The results indicated that in no case did the isotope scan demonstrate greater intramedullary extension of tumor than the routine roentgenographic examination. In addition, despite good correlation between the roentgenogram, scan, and histologic evaluation of tumor extent, all of which showed no evidence of malignancy near the area of surgery,there have been to date 3 local recurrences.