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Biomedical subjects

A Cotten

Publications and source records attributed to A Cotten.

At least 37 records · Page 2Linked to original sources
PubMed2000

MR imaging of the knee at 0.2 and 1.5 T: correlation with surgery.

OBJECTIVE: The purpose of this study was to compare the diagnostic efficacy of low- and high-field-strength MR imagers in the diagnosis of anterior cruciate ligament tears and meniscus tears. SUBJECTS AND METHODS: In 219 patients with suspected internal derangement of the knee, MR imaging at 0.2 and 1.5 T was performed with similar sequences. Only patients with surgically confirmed diagnosis (n = 90) were included in the statistical analysis. Radiologists were unaware of diagnosis and field strength. Sensitivity, specificity, diagnostic accuracy, and inter- and intraobserver variability were determined. RESULTS: There was excellent correlation between the field strengths in accuracy, sensitivity, and specificity for anterior cruciate ligament and meniscus tears. Accuracy for medial meniscus, lateral meniscus, and anterior cruciate ligament tears was 91-93%, 88-90%, and 93-96%, respectively, at 0.2 T and 91-94%, 91-93%, and 97-98%, respectively, at 1.5 T. Inter- and intraobserver variability values showed excellent correlation (kappa > 0.8). CONCLUSION: The level of diagnostic accuracy in anterior cruciate ligament tears and meniscus tears is comparable for low- and high-field-strength MR imagers.

Adolescent↗
PubMed2000

Thoracic outlet: anatomic correlation with MR imaging.

OBJECTIVE: The purpose of this report is to describe the normal MR anatomy of the thoracic outlet and its modification after postural maneuvers using an anatomic-MR imaging correlation. CONCLUSION: MR imaging appears to be a useful technique to study the thoracic outlet and its contents because of its excellent soft-tissue depiction and its multiplanar capabilities. T1-weighted images obtained in the sagittal plane clearly depicted the different compartments of the cervicothoracic-brachial junction. Hyperabduction maneuvers may have potential applications in the assessment of the thoracic outlet syndrome by showing the location of compression.

Aged↗
PubMed2000

[Cortical septic osteitis: two cases].

Cortical septic osteitis is defined as a predominant or exclusive infection of the cortex which may lead to diagnosis pitfalls. With the two cases presented here, principal radiological features allowing a correct diagnosis are recalled.

Adult↗
PubMed2000

Arthritis, tenosynovitis, fasciitis, and bursitis due to sea urchin spines. A series of 12 cases in Réunion Island.

UNLABELLED: Arthritis, tenosynovitis, and bursitis due to sea urchin spine injuries have unique pathological features and run a chronic course until the spines are removed. Of the 40 cases of sea urchin spine-related clinical symptoms published to date, only 12 had osteoarticular symptoms. PATIENTS AND METHODS: We studied 12 cases with osteoarticular symptoms seen in Réunion Island from 1994 to 1998. There were nine cases of arthritis and one case each of tenosynovitis, fasciitis, and bursitis. The nine males and three females had an age range of 9 to 50 years. RESULTS: The injury was at the knee in six cases, the foot in three, and the hand in three. The time from injury to lesion development ranged from two days to two and a half months. Laboratory tests were normal apart from evidence of mild inflammation in three of the arthritis cases. The spine was visible on plain radiographs in eight cases. Histology was done in seven patients and consistently showed a typical foreign body granuloma. Removal of the spine with synovectomy was performed in 11 cases and consistently ensured a full recovery. DISCUSSION: The clinical manifestations and management in our patients were compared to those in earlier reports. The differential diagnosis of laboratory test, radiographic, and histologic findings is reviewed. Pathogenic hypotheses and the immunogenic effect of the protein sheath that surrounds sea urchin spines are discussed. CONCLUSION: The diagnosis of these frequently under-recognized lesions rests on a careful history and on converging histologic, radiologic, and clinical findings.

Adolescent↗
PubMed2000

Long-term efficacy of percutaneous drill-biopsy under computed tomography guidance of osteoid osteomas of the hip and femur. A review of seven cases.

UNLABELLED: En bloc surgical excision of osteoid osteomas of the hip and femur is difficult because of problems with tumor boundary identification and the need to use internal fixation or bone grafting. We report our experience with seven cases treated by percutaneous drill-biopsy under computed tomography guidance. PATIENTS: Six adults and one child with a mean age of 22 years treated since 1995. All seven patients reported insomnia due to pain during a mean of 10 months, improved by aspirin or other nonsteroidal anti-inflammatory agents. The tumor was seen on plain radiographs in four cases and on computed tomography scans in all seven cases. Magnetic resonance imaging was diagnostic in only two cases. The tumor was in the femoral neck in four patients, in the acetabulum in one, in the proximal femur in one, and at the distal diaphyseal-metaphyseal junction of the femur in one. METHOD: A trephine was used to remove the tumor under computed tomography guidance during a short general anesthesia. RESULTS: No serious complications were recorded. Full weight bearing was allowed starting at the forty-eighth hour in six of the seven patients. Immediate pain relief and a full recovery were obtained in every case. Results were excellent in four patients and good in three after a follow-up of 14 to 44 months. CONCLUSION: Percutaneous drill-biopsy of osteoid osteomas is a valuable alternative to conventional surgery in patients with tumors at sites that are difficult to access. The technique allows early weight bearing and ensures a full recovery.

Adolescent↗
PubMed2000

[Imaging of synovial lesions, neoplastic or non-neoplastic].

The purpose of this paper is to present the contribution of imaging in the assessment of synovial diseases, especially in the differentiation between infectious synovitis and rheumatoid arthritis, and in the diagnosis of tumoral and pseudotumoral synovial lesions (idiopathic (osteo)chondromatosis, pigmented villonodular synovitis, synovial hemangioma, lipoma arborescens...).

Bone Neoplasms↗
PubMed2000

Rheumatologic manifestations of pachydermoperiostosis and preliminary experience with bisphosphonates.

OBJECTIVE: Pachydermoperiostosis is manifested by finger clubbing, hypertrophic skin changes, and periosteal bone formation. We describe 5 cases revealed primarily by their rheumatologic manifestations. Also reported are preliminary experiences on the use of intravenous pamidronate as a treatment. METHODS: This is a retrospective study including the analysis of clinical manifestations, laboratory results and morphological examinations gathered from patients' medical records. We evaluated efficacy of treatment with 1 mg/kg iv pamidronate in the 3 new cases. RESULTS: Before treatment with iv pamidronate, the patients' global assessment was poor (twice) and very poor (once). The physician's global assessment was poor in 3 patients. After treatment with iv pamidronate, 2 patients had significant improvement. Physician and patient global assessments were very good, good, and moderate. No side effects were observed. All biological variables were within normal ranges at 12 month followup visit. CONCLUSION: Pachydermoperiostosis must be recognized by the rheumatologist, since it can present symptomatically through articular manifestations. When conventional treatment modalities fail, iv pamidronate might be useful.

Adult↗
PubMed1999

[Imaging of the shoulder].

Except for instability, a variety of causes has been described in the painful shoulder. A thorough clinical examination may help establish the cause of shoulder pain. Even if modern imaging modalities (ultrasonography, computed tomography, MR imaging) allowed a precise diagnostic and therapeutic approach, plain radiographs are still necessary. Performed by an experienced radiologist, ultrasonography may be useful for the assessment of rotator cuff tears which are a common problem. CT arthrography and MR imaging are only recommended in preoperative assessment. In calcific tendinitis plain radiographs provide evidence of calcifications. It is not difficult to establish clinically the diagnosis of adhesive capsulitis and arthrography is the only technique to reveal the articular capacity limitation reliably. In degenerative osteoarthritis of the glenohumeral joint, CT arthrography is necessary to assess the rotator cuff changes and lenoid osseus findings before undergoing shoulder arthroplasty.

Diagnosis, Differential↗
PubMed1999

Image analysis of the distal radius trabecular network using computed tomography.

Bone texture analysis might provide information about bone structure in a noninvasive manner. In a prospective case-control cross-sectional study we investigated the value of computed tomography (CT) image analysis of the distal radius in the assessment of osteoporosis. Twenty patients suffering from postmenopausal osteoporosis were studied and compared with 21 age-matched controls. Eight slices were selected in each patient: four consecutive coronal slices and four consecutive cross-sectional slices. Bone texture analysis was performed using statistical, fractal and structural methods leading to the measurement of 32 features. Structural variables derived from histomorphometric parameters were measured after segmentation from a binary or a skeletonized image. Bone mineral density was measured by dual-energy X-ray absorptiometry both at the lumbar spine and the femoral neck. Eight of the 9 statistical features were significantly different in osteoporotic women as compared with controls (coronal slices, p < 0. 05). Seven structural variables were statistically different between the two groups on coronal slices (p < 0.05): valley surface area, bone volume/tissue volume, trabecular partition, Euler's number, trabecular bone pattern factor, node-to-node strut count and terminus-to-terminus strut count. The most significant results on coronal slices (p < 0.01) concerned 4 structural features: trabecular partition, Euler's number, trabecular bone pattern factor and terminus-to-terminus strut count. Three features were statistically different (p < 0.01) between the two groups on cross-sectional slices (skeletonization from gray levels). A few features yielded by texture analysis were correlated with both lumbar spine and femoral neck bone mineral density, but the level of these correlations was weak (r < 0.5). In conclusion, CT image analysis of the distal radius is a useful tool for characterizing bone texture alterations in osteoporotic women. These findings are in keeping with microarchitectural osteoporosis-related changes diagnosed on bone biopsies.

Aged↗
PubMed1999

[Muscle infarction. An unknown complication of diabetes mellitus].

INTRODUCTION: Diabetic muscle infarction (MI) is a rare and little-known complication of diabetes mellitus. CASE REPORT: We report a case of relapsing MI in which magnetic resonance imaging (MRI) suggested the diagnosis. A 53-year-old man with multi-complicated type II diabetes mellitus was admitted to our unit for illness and deep tumefaction of the right thigh. Because of unconclusive MRI, a muscular biopsy of the lesion was performed and MI confirmed. Three months after, a left relapse of MI occurred. Immediate treatment with immobilization and heparinotherapy permitted a rapid recovery. CONCLUSION: About 70 previously reported cases are reviewed. The mean age at presentation was about 40 years. MI was usually seen in patients with long-standing diabetes with multiple end organ microvascular complications. Homo- or heterolateral recurrences are reported in almost half of the patients. MRI is the best imaging technique for suggesting the diagnosis.

Diabetes Mellitus, Type 2↗
PubMed1999

Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study.

OBJECTIVE: To assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures responsible for severe and persistent pain. METHODS: Sixteen patients were included in this open prospective study. Inclusion criteria were: one or 2 vertebral fractures responsible for severe pain, i.e., higher than 50 mm on a visual analog scale (VAS: 0-100 mm), scores 3, 4 or 5 according to the McGill-Melzack scoring system, and evolving for more than 3 months. Assessment criteria were the changes over time (Days 3, 30, 90, 180) in VAS and McGill-Melzack scoring system. The changes over time in a generic health status instrument score [the Nottingham Health Profile (NHP)] were also assessed. Statistical comparisons were performed using the Wilcoxon T test. RESULTS: There were 9 women and 7 men: postmenopausal osteoporosis (n = 7), corticosteroid induced osteoporosis (n = 2), and male osteoporosis (n = 7). Vertebroplasty was performed in 20 vertebrae. A statistically significant decrease of both VAS (-53%, p < 0.0005) and McGill-Melzack scoring system (p < 0.005) was observed at Day 3. The results were also significant at Days 30, 90, and 180 for both scales (p < 0.005 and p < 0.01, respectively). A significant decrease over time for 5/6 dimensions of the NHP score was also noted: pain (p < 0.01), physical mobility (p < 0.05), emotional reactions (p < 0.05), social isolation (p < 0.05), and energy (p < 0.05). We observed no adverse event, and no vertebral fracture has occurred after 6 months of followup. CONCLUSION: Percutaneous vertebroplasty is a useful and safe procedure for treating persistent painful osteoporotic fractures. Controlled studies with longterm followup are required.

Aged↗
PubMed1999

Contribution of magnetic resonance imaging to the diagnosis of extraskeletal Ewing's sarcoma.

A case of extraskeletal Ewing's sarcoma presenting as a large gluteal mass is reported. This is a rare tumor with a frequently grim prognosis. Although the definitive diagnosis requires histological examination, magnetic resonance imaging is useful for determining the location of the tumor, evaluating its spread, and eliminating skeletal Ewing's sarcoma by establishing the integrity of the neighboring bone marrow. The tumor is seen on T1-weighted images as low signal with heterogeneous postgadolinium enhancement. Signal intensity on T2-weighted images is variable. In the case reported here, combination chemotherapy with external beam radiation therapy was ineffective, and the patient died 12 months after the diagnosis.

Adult↗
PubMed1998

Magnetic resonance imaging of the forearm: cross-sectional anatomy in a cadaveric model.

RATIONALE AND OBJECTIVES: Compartmental anatomy of the forearm is complex and controversial. The purpose of this investigation was to demonstrate via magnetic resonance the anatomy of forearm compartments and their preferential ways of communication in a human cadaveric model. METHODS: Twelve forearm spaces (11 muscles and one intermuscular) were injected with a solution containing gadopentetate dimeglumine. The extent and distribution of leakage were evaluated on axial fat-suppressed T1-weighted spin-echo images. The findings were related to known descriptions of compartmental anatomy of the forearm. RESULTS: Contrast leakage occurred mostly into the intermuscular space and into the muscles adjacent to the injected muscle. A frank communication within the classically described three forearm compartments (volar, radial, and dorsal) was not present. The interosseous membrane was not an absolute barrier between flexor and extensor compartments. CONCLUSION: The classic description of three forearm compartments may not be sufficient to explain distribution of soft tissue abnormalities.

Aged↗