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Biomedical subjects

A Cotten

Publications and source records attributed to A Cotten.

90 records · Page 5Linked to original sources
PubMed1994

Foraminal lumbar disc herniation. Experience with 83 patients.

STUDY DESIGN: This study analyzed a series of 83 patients operated on for foraminal lumbar disc herniation. OBJECTIVES: This study sought to develop clinical and radiologic diagnoses, evaluate interlaminar and extra-articular exposures, and evaluate postoperative results. SUMMARY OF BACKGROUND DATA: Some authors have reported a specific clinical syndrome, but other reports have indicated the clinical picture is indistinguishable from usual posterolateral disc herniation. Surgical management often has been compared between the interlaminar and extra-articular approaches. METHODS: Clinical findings were reviewed. All patients were evaluated with computed tomography, but radiologic diagnosis required computed tomographic discography for 26 patients. Interlaminar exposure with partial medial facetectomy was performed in 73 patients and an extra-articular approach was necessary in 10 patients. Postoperative results were evaluated with a 2-year follow-up. RESULTS: Foraminal lumbar disc herniations have a specific clinical picture, particularly severe radicular signs. Precise preoperative radiologic evaluation is essential for successful operative procedure. Postoperative results were good in 76% of the patients. The other patients felt mild residual radicular pain, although no residual root compression was found on postoperative computed tomography. Only 21% of the patients that had a radicular deficit recovered totally. CONCLUSIONS: Foraminal lumbar disc herniation involves characteristic clinical features. Radiologic diagnosis requires high-resolution computed tomography, computed tomographic discography, or magnetic resonance imaging. Most foraminal lumbar disc herniations are reached through the interlaminar exposure extended to the upper lamina and medial facet without total facetectomy. An extra-articular approach should be reserved for extra-foraminal herniations.

Diskectomy↗
PubMed1994

Antenatal differentiation of the human intervertebral disc.

To study the antenatal differentiation of the human intervertebral disc, the columns of forty eight embryos and fetuses were examined histologically. The primitive disc is composed of two structures: the notochord which shows a progressive expansion into the disc, and the fibro-cartilaginous perinotochordal disc. No histological sign of interaction between notochordal and perinotochordal cells, which may explain the notochordal expansion into the discs, was seen. On the other hand, the notochordal intervention in the cartilaginous differentiation of the inner zone is probable.

Gestational Age↗
PubMed1994

[Diagnostic value of spinal puncture-biopsy in non-infectious spinal diseases. Apropos of 41 cases].

To evaluate the diagnostic value of percutaneous vertebral biopsy in noninfectious diseases of the spine, we retrospectively studied 41 cases seen between 1985 and 1992. The level of the lesion was lumbar in 29 cases, thoracic in 11, and cervical in one. There were 19 crush fractures, 11 lytic lesions, six sclerotic lesions, and three mixed lesions. The biopsy was done because of an abnormal magnetic resonance imaging signal in one patient and because of epiduritis in another. The thoracic and lumbar biopsies were done under x-ray guidance using the technique developed by Laredo and Bard. Computed tomography guidance was used for the cervical biopsy. There were no adverse events. The final histological diagnosis was metastatic disease in 17 cases (41.5%), myeloma or plasmacytoma in six cases (14.7%), primary vertebral neoplasia in two cases (4.8%), lymphoma in one case (2.4%), osteoporosis in nine cases (22%), Paget's disease in three cases (7.4%), amyloidosis in one case (2.4%), aseptic osteitis in one case (2.4%), and vertebral necrosis in one case (2.4%). A second biopsy procedure was done in three patients (surgically in two cases and percutaneously in one) because of discrepancies between histological findings and other data. The final diagnosis was metastatic disease in all three patients. Overall, the diagnostic yield of percutaneous vertebral biopsy was 92.6% and varied little with initial roentgenographic or computed tomographic findings. However, yield was only 56% for the diagnosis of tumorous lesions, with variations according to roentgenographic and computed tomographic changes, 90.1% for osteolytic lesions, 66.6% for mixed lesions, 47.4% for crush fractures, and 16.6% for sclerotic lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Hip diseases in hemorrhagic rectocolitis. Apropos of 4 cases].

Erosive hip lesions are uncommon in patients with ulcerative colitis. We analyzed features of chronic hip lesions in four ulcerative colitis patients seen over the last 30 years. Two patients also had axial disease. Both hips were involved in all four cases. Roentgenographic features resembled those seen in ankylosing spondylitis in two cases. Severe destruction occurred in two patients. Two patients developed acetabular protrusion. All four patients rapidly required total hip arthroplasty, illustrating the poor prognosis of hip lesions associated with ulcerative colitis.

Adolescent↗
PubMed1994

[Pigmented villonodular synovitis of the hip. Results of a national survey apropos of 58 cases].

Pigmented villonodular synovitis is an uncommon synovial disease which only rarely involves the hip. In a multicenter retrospective study, we identified 58 histologically-proven cases. There were 33 females and 25 males. Mean age at diagnosis was 38 years. In all but two cases, only one hip was involved; the right hip was affected somewhat more often (33 cases) than the left. Two patients probably had bilateral hip disease. Mean delay to diagnosis was four years. Pain was the presenting symptom in most cases. A palpable mass in the groin was found in six patients. Plain roentgenograms were considered normal in only three patients. Bony cysts were seen in 39 patients and kissing cysts in 19. Joint space narrowing was found in 40 patients and was diffuse in half the cases. Roentgenograms suggested pigmented villonodular synovitis in 63% of cases, osteoarthritis of the hip in 16%, and inflammatory hip disease in 14%. Additional imaging studies included opaque arthrography in 21 subjects, computed tomography in 23, magnetic resonance imaging in 11, and arthroscopy in 9. Initial treatment was osmic acid synoviorthesis in 14 patients, partial synovectomy in 9, and total synovectomy in 21; in addition, eight patients had insertion of a cup prosthesis and 13 had total arthroplasty of the hip. Treatment was successful in 65% of cases after a mean follow-up of three years; among the 35% of failures, there were seven recurrences (14%). Total hip arthroplasty was performed secondarily in nine patients. This study illustrates the diversity of roentgenological changes in pigmented villonodular synovitis of the hip and the high frequency of osteoarticular lesions precluding conservative treatment. Magnetic resonance imaging and/or arthroscopy should be used to establish the diagnosis at an early stage when conservative treatment with total synovectomy and synoviorthesis is most likely to be successful.

Adolescent↗
PubMed1994

[Value of vertebroplasty combined with surgical decompression in the treatment of aggressive spinal angioma. Apropos of 3 cases].

Vertebral hemangiomas can cause difficult-to-treat neurological complications. We report our experience with three such cases. Patients no. 1 and 2 were females aged 64 and 71 years, respectively; patient no. 1 had a two-year history of weakness in the lower limbs and patient no. 2 had a five-month history of back pain. Both these patients had a pyramidal syndrome in the lower limbs. Patient no. 3 was a 61 year old male with a one-year history of left sciatica. Roentgenograms were suggestive of a hemangioma occupying the entire T8 (cases 1 and 2) or L5 (case 3) vertebra. Computed tomography and magnetic resonance imaging confirmed this diagnosis and showed that patients 1 and 2 had an anterior epidural hemangioma opposite T8 impinging on the spinal cord. In patients 1 and 2, treatment consisted in embolization of T8 followed by transpedicular injection of 6 cc of methylmethacrylate into the body of T8. One cubic centimeter of histoacryl was also injected in each lamina. The third patient had a similar vertebroplasty procedure without prior embolization since he had no epidural hemangioma. One patient (no. 1) developed intercostal neuralgia of several hours duration after the procedure. All three patients subsequently underwent laminectomy (T7-T8 with removal of the epidural hemangioma in cases 1 and 2, L5 in case 3). The pyramidal syndrome resolved within 15 days in patients 1 and 2; the nerve root pain resolved within 48 hours in patient 3.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Causes of dislocation of total hip arthroplasty. CT study of component alignment.

We reviewed radiographs and CT scans of 38 total hip arthroplasties which had dislocated (36 posteriorly; 2 anteriorly) and compared the alignment of the prosthetic components with those of 14 uncomplicated arthroplasties. No difference was found between the alignment of the prosthetic components in the two groups. In the seven patients who had reoperations, the cause of dislocation diagnosed by CT was confirmed in only two cases (one retroversion of the cup and one protruding osteophyte). Muscular imbalance rather than malposition of the components was the major factor determining dislocation. CT allows accurate measurement of cup and neck anteversion but contributes little to preoperative planning.

Adolescent↗
PubMedDate not supplied

MR arthrography of the elbow: normal anatomy and diagnostic pitfalls.

PURPOSE: Our goal was to determine the normal MR arthrographic appearance of the elbow and to identify the potential diagnostic pitfalls of this technique. METHOD: MRI with intra-articularly administered gadopentetate dimeglumine was performed in seven elbow joints derived from cadavers. Coronal, sagittal, and axial SE T1-weighted images with fat suppression and coronal 3D SPGR images with fat suppression were obtained in each elbow. The elbows were then sectioned. RESULTS: This technique allowed depiction of the cartilaginous surfaces of the elbow joint as well as clear delineation of the inner surface of the collateral ligaments. Potential diagnostic pitfalls included fat pads projecting into the joint, synovial folds, and cartilaginous pseudoerosions. CONCLUSION: MR arthrography allows clear delineation of the intraarticular structures of the elbow. However, diagnostic pitfalls exist that increase the difficulty of interpreting MR arthrographic images.

Aged↗
PubMedDate not supplied

Acetabular labrum: MRI in asymptomatic volunteers.

PURPOSE: The purpose of this study was to describe the MR appearance of the acetabular labrum in asymptomatic hips on high resolution MRI. METHOD: Fifty-two hips in 46 asymptomatic volunteers with an age range of 15-85 years were evaluated with coronal and axial T1-weighted and T2-weighted sequences. The shape, margin, size, and signal intensity of the acetabular labrum were analyzed. RESULTS: The labrum was absent in its anterosuperior aspect in five hips (10%). Intralabral regions of intermediate of high signal intensity were detected in 30 hips (58%) imaged with T1-weighted and proton density-weighted sequences. Intralabral linear hyperintense foci reaching the articular surface and consistent with a labral tear were detected in four labra on T2-weighted images. Intralabral microcysts were seen in three labra. CONCLUSION: The MR appearance of the hip labrum is varied in asymptomatic volunteers. Intralabral increased signal intensity and absent anterosuperior labra are especially frequent and may represent asymptomatic lesions or normal variations.

Acetabulum↗
PubMedDate not supplied

Percutaneous vertebroplasty: state of the art.

Vertebroplasty is an effective new radiologic procedure consisting of the percutaneous injection of a biomaterial, usually methyl methacrylate, into a lesion of a vertebral body. This technique allows marked or complete pain relief and bone strengthening in most cases. The principal indications for vertebroplasty are osteolytic metastasis and myeloma, painful or aggressive hemangioma, and osteoporotic vertebral collapse with debilitating pain that persists despite correct medical treatment. Radiography and computed tomography must be performed in the days preceding vertebroplasty to assess the extent of vertebral collapse, the location and extent of the lytic process, the visibility and degree of involvement of the pedicles, the presence of cortical destruction or fracture, and the presence of epidural or foraminal stenosis caused by tumor extension or bone fragment retropulsion. Leakage of methyl methacrylate during vertebroplasty may cause compression of adjacent structures and necessitate emergency decompressive surgery; thus, the procedure should be performed only in a surgical center. The decision to perform vertebroplasty should be made by a multidisciplinary team because the choice between vertebroplasty, surgery, radiation therapy, medical treatment, or a combination thereof depends on a number of factors. Radiologists need to be aware of the various indications for vertebroplasty and of potential future developments and applications of the procedure.

Hemangioma↗
PubMedDate not supplied

Extrinsic and intrinsic ligaments of the wrist: normal and pathologic anatomy at MR arthrography with three-compartment enhancement.

The ligaments of the wrist have been demonstrated with magnetic resonance (MR) imaging by many authors. Distinction has been made between the extrinsic, or radiocarpal and ulnocarpal, ligaments and the intrinsic, or intercarpal, ligaments. The stability of the wrist depends on numerous ligaments: The volar ligaments are important stabilizers of the wrist, whereas the dorsal ligaments are less crucial for wrist stability. An MR imaging protocol that demonstrates these structures with high resolution has been developed. Cadaveric wrists are imaged with a spoiled gradient-recalled-echo volume-acquisition technique with fat suppression after three-compartment enhancement with a contrast agent containing gadolinium. The specimens are then sectioned, and the anatomic and pathologic findings are correlated with the findings on the MR images. The extrinsic and intrinsic ligaments of the wrist are clearly demonstrated with this technique. This protocol was designed for anatomic study and promotes understanding of the anatomy and biomechanics of the wrist; it is not intended for clinical use.

Angiography↗
PubMedDate not supplied

Fat suppression in MR imaging: techniques and pitfalls.

Fat suppression is commonly used in magnetic resonance (MR) imaging to suppress the signal from adipose tissue or detect adipose tissue. Fat suppression can be achieved with three methods: fat saturation, inversion-recovery imaging, and opposed-phase imaging. Selection of a fat suppression technique should depend on the purpose of the fat suppression (contrast enhancement vs tissue characterization) and the amount of fat in the tissue being studied. Fat saturation is recommended for suppression of signal from large amounts of fat and reliable acquisition of contrast material-enhanced images. The main drawbacks of this technique are sensitivity to magnetic field nonuniformity, misregistration artifacts, and unreliability when used with low-field-strength magnets. Inversion-recovery imaging allows homogeneous and global fat suppression and can be used with low-field-strength magnets. However, this technique is not specific for fat, and the signal intensity of tissue with a long T1 and tissue with a short T1 may be ambiguous. Opposed-phase imaging is a fast and readily available technique. This method is recommended for demonstration of lesions that contain small amounts of fat. The main drawback of opposed-phase imaging is unreliability in the detection of small tumors embedded in fatty tissue.

Adipose Tissue↗
PubMedDate not supplied

Therapeutic percutaneous injections in the treatment of malignant acetabular osteolyses.

Percutaneous injection of methylmethacrylate or ethanol may provide marked pain relief or bone strengthening in patients with malignant acetabular osteolyses who are unable to tolerate surgery. Injection of methylmethacrylate is usually indicated when osteolysis involves the weight-bearing part of the acetabulum (ie, the acetabular roof); in all other cases, ethanol injection is preferred. Ethanol and methylmethacrylate injections may be performed together if both weight-bearing and nonweight-bearing parts of the acetabulum are involved or extensive soft-tissue involvement is present. Moreover, these injections may be performed prior to radiation therapy, which complements their action due to similar but delayed effects on pain, or after radiation therapy that failed to relieve pain or in cases of local recurrence. Radiography and computed tomography must be performed prior to therapeutic percutaneous injection to assess the location and extent of the lytic process, the presence of cortical destruction or fracture, and the presence of soft-tissue involvement. Fever and transitory worsening in pain may occur secondary to inflammatory reaction in the hours following injection; however, these side effects usually resolve spontaneously within 1-3 days. The decision to perform therapeutic percutaneous injections should be made by a multidisciplinary team because the choice between this option and alternative methods of treatment depends on several factors including the location of the lesion, the local and general extent of the disease, the pain and functional disability experienced by the patient, and the patient's state of health and life expectancy.

Acetabulum↗
PubMedDate not supplied

Axial osteomalacia with sacroiliitis and moderate phosphate diabetes: report of a case.

We report a new case of axial osteomalacia diagnosed in a 51-year-old white Caucasian male, made particular by its association with sacroiliitis, positive HLA-B27 antigen, and also moderate phosphate diabetes responsible for a decreased appendicular bone mass. The diagnosis was suspected when X-ray evaluation showed increased density and coarse trabeculation mainly involving the pelvis and spine. Dual energy X-ray absorptiometry confirmed the elevated bone density at the lumbar spine (T score: +1.92) contrasting with a decreased bone mass at the femoral neck (T score: -2.33). The diagnosis was confirmed by histomorphometry of the iliac crest showing marked thickening of the cortices (2190 microns +/- 0.574, N = 780 +/- 40) and an increased trabecular bone volume (33.24%, N = 14 +/- 3). Osteoid parameters were also markedly increased with an osteoid volume of 2.1% (N = 1.2 +/- 0.5) and a mean osteoid thickness of 28.7 microns (N = 13 +/- 2.5), with a normal bone fluoride content (0.082%, N < 0.10). Bone resorption as assessed on bone biopsy and by the measurement of markers of bone remodeling (serum procollagen type I C-terminal telopeptide and 24 hr urinary cross-laps to creatinine ratio) was increased. This latter finding was not necessarily due to axial osteomalacia and could be the consequence of moderate phosphate diabetes. The patient was treated with calcitriol which was promptly discontinued due to gastrointestinal symptoms and replaced by calcidiol without any significant effect on the low back pain.

Absorptiometry, Photon↗
PubMedDate not supplied

[Normal and pathological aspects of the glenoid labrum in opaque arthro-scanner].

The morphology of the glenoid labrum was studied by CT arthrography in 88 patients. These were divided in 2 groups. In the first group, the patients underwent CT arthrography for a clinical instability of the shoulder. The second group was the reference group to study the morphology of the glenoid labrum, it included patients with rotator cuff tears or other pathology of the shoulder, without clinical instability. We described the normal labrum which presents important morphologic variations. Its study may be difficult because of the proximity of capsular structures of the shoulder, mainly the gleno-humeral ligaments. The normal variants and the pathologic aspects of the labrum were studied: the clefts, tears and degenerative phenomenous. The cleft aspect was studied comparatively in the instable population and in the reference population.

Arthrography↗