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Biomedical subjects

A Hadjipavlou

Publications and source records attributed to A Hadjipavlou.

At least 19 recordsLinked to original sources
PubMed1996

The causes of failure of lumbar transpedicular spinal instrumentation and fusion: a prospective study.

A prospective study was made of 101 patients who underwent transpedicular spinal instrumentation and fusion of the lumbar spine. All were reviewed by an independent observer. The objectives were to determine the causes of clinical failure and to recommend preventive measures. Forty-two primary and 59 revision operations were performed. The average age was 46 years and follow up 4 years. The variable screw placement and Cotrel-Dubousset systems were used. Posterior lumbar interbody fusion was carried out in 24 patients. The outcome was satisfactory after primary operations in 67% and after revisions in 46%. Nerve root injuries due to screw placement occurred in 4% (2% permanent and 2% transient). Instrumentation-induced foraminal stenosis developed in 2%. Proper surgical technique can avoid these complications. Predictive factors for failure are: abnormal psychology, symptomatic epidural fibrosis, inadequate decompression of lateral stenosis, surgical complications and the use of allografts.

Adolescent↗
PubMed1996

Unicompartmental knee arthroplasty with patelloplasty.

Patellofemoral arthritis is generally regarded as a contraindication to unicompartmental knee arthroplasty. A retrospective review of 52 patients (60 knees) who underwent this operation together with nonresurfacing excisional patelloplasty was carried out. The patellar facets were resected through subchondral bone retaining the triangular shape of the bone. There were 90% good and excellent results at an average follow-up of 6 years with no patellofemoral pain, despite marked to moderate patellofemoral crepitus in 98%. Patellofemoral arthroplasty can extend the indications for unicompartmental knee arthroplasty, providing an alternative to total knee replacement.

Arthritis↗
PubMed1994

Percutaneous transpedicular biopsy of the spine.

STUDY DESIGN: Despite increasing information regarding pedicular instrumentation, the transpedicular biopsy of the vertebral body has not been popularized. The precise technique for percutaneous transpedicular biopsy and the volume of the vertebral body accessible through the pedicle has not been reported. OBJECTIVE: To describe the percutaneous transpedicular biopsy, its diagnostic yield, to determine the amount of bone retrievable through the pedicle. SUMMARY OF BACKGROUND DATA: Experience gained from open biopsy facilitates the development of the percutaneous technique. There were no complications with the open or closed procedures. METHODS: Transpedicular biopsy was performed on 18 patients (nine open and nine percutaneous). Unilateral transpedicular curetments were performed on the cadaveric lumbar spines. The volume of the vertebral body accessible through the pedicle was determined using roentgenograms, computed tomography, and image analysis. RESULTS: Adequate specimens for a correct diagnosis were obtained in all biopsies. Laboratory volumetric analysis demonstrated that more than 50% of the volume of a lumbar vertebral body is accessible through a unilateral transpedicular approach, without compromising the anatomic structure of the pedicle. CONCLUSIONS: The vertebral pedicle provides a safe conduit for biopsy of most vertebral body lesions. Percutaneous transpedicular biopsy can be performed with minimal morbidity and high diagnostic yield.

Adult↗
PubMed1993

[Chemonucleolysis. Its effectiveness in the treatment of lumbar diskopathies caused by compressive or rotational injuries].

One hundred patients who meet McCulloch's indicators for treatment of lumbar disc herniation by chemonucleolysis were entered in this study. Chemonucleolysis in the patients suffering from sciatica secondary to a compression injury, especially with clinical and radiographic evidence of nerve root compression at a single level, can be expected to attain good to excellent results. Chemonucleolysis is far less efficacious in patients suffering from either torsional injury or multiple level abnormality, especially in the absence of neurological deficit. Meticulous attention to patient selection will yield optimal results. The result was excellent or very good in 60% of patients, while in 40% the procedure failed. The rate of success at the L.5/S.1 level was 70%, at the L.4/5 level it was 63% and 37% were successful when multiple levels were treated.

Adult↗
PubMed1992

Malignant transformation in Paget disease of bone.

BACKGROUND: The previously reported incidence of malignant transformation of Paget disease up to 5.5% and its dismal prognosis have prompted the clinical investigation of a large population with Paget disease. METHODS: A chart review of symptomatic and asymptomatic patients with a diagnosis of Paget disease between 1970 and 1985 at four large Montreal Hospitals revealed 1078 patients. Eight patients with malignant transformation were studied in detail. RESULTS: The incidence of malignant transformation was 0.7%, and the most frequent histologic type was osteogenic sarcoma. The most prevalent site was the femur, and pathologic fracture with focal osteolysis was present in 50% of patients at the initial appearance of the tumor. Healing at the fracture site was demonstrated in one patient. Another patient died of uncontrollable hemorrhage. A case of malignant lymphoma in Paget disease is recorded. CONCLUSIONS: Surgery or biopsy should be preceded by preoperative scintigraphic bone blood flow evaluation and, if necessary, administration of a preoperative course of mithramycin and selective embolization to minimize bleeding. The prognosis of malignant transformation in Paget disease is poor, although one patient with malignant lymphoma survived after aggressive treatment. Early biopsy and aggressive treatment should not be delayed.

Adult↗
PubMed1992

The effect of chymopapain on low back pain.

One hundred and fifteen patients underwent chymopapain treatment for acute disc protrusion between 1980 and 1988. Sixty-six patients who were treated with single-level injection were reviewed retrospectively with clinical follow-up from 2 to 10 years (mean, 4.6 years). All patients met modified McCulloch criteria (not all patients had leg pain greater than back pain). The presence of pre-existing chronic low back pain (LBP) was recorded in 33 patients and compared to their present low back symptomatology and functional limitations. Patients with pre-existing chronic LBP had a success rate of 52%, whereas patients meeting all the McCulloch criteria without chronic LBP had a success rate of 52%, whereas patients meeting all the McCulloch criteria without chronic LBP had a success rate of 85%. The overall effect of chemonucleolysis on LBP demonstrated no change in 18% and a mild increase in 45% of the patients (even though they had a successful outcome). The pre-existing disc space narrowing and the postoperative change of disc space height of 33 patients assessed on lateral roentgenograms showed no correlation to the clinical response. Temporal sequential computed tomography scan assessment of 56 patients following chemonucleolysis demonstrated little change of disc herniation in the first 3 months, with only a gradual and incomplete resolution in the ensuing 12 months.

Adult↗
PubMed1991

Whole body retention of Tc-99m phosphate in Paget's disease of bone.

The effectiveness of the 24-hour whole body retention of Tc-99m MDP in monitoring disease activity was evaluated in 58 patients with Paget's disease of bone. Patients had baseline 24-hour retention studies, bone scans, radionuclide bone blood-flow studies, and alkaline phosphatase and OH-Proline level measurements. Increased retention of Tc-99m MDP was present in 88% (51/58) of individuals while alkaline phosphatase and OH-Proline were respectively elevated in 100% (58/58) and 64% (35/55) of patients. Forty-seven examinations were further obtained to evaluate changes in retention with therapy. Retention correctly reflected response to treatment in 89.3% of follow-ups versus 85.1% with alkaline phosphatase (n = 47). It was accurate in 90.9% of patients versus 75% for OH-Proline (n = 44). We conclude that the retention study, while not absolutely correlative with Pagetic activity, still is useful in grading the condition. It is a simple additional step that monitors the global severity of lesions localized on bone scans.

Aged↗
PubMed1991

Intradiscal invasion of Paget's disease of the spine.

A retrospective study of 84 patients with Paget's disease of the spine revealed 9 who developed pagetic intradiscal invasion from the adjacent vertebral bodies. Two patients were asymptomatic. One patient had back pain, one had symptomatic intraforaminal stenosis without back pain, and five had clinical and radiologic spinal stenosis and spine pain; of these five, one demonstrated clinical and radiologic findings indistinguishable from spondylodiscitis. The incidence of intradiscal transgression in Paget's disease of the spine was 10.7%. Spinal pain was present in 67% patients; 22% were asymptomatic. This study shows that disc pathology is not invariably associated with spinal pain.

Aged↗
PubMed1991

Paget disease of the spine.

Seventy patients who had the radiographic features of Paget disease of the spine were evaluated clinically and with computed tomography, with the objective of correlation of the symptoms with the lesions. Of forty-five symptomatic patients, twenty-one had only pain in the back or neck and twenty-four patients had spinal stenosis with or without pain in the back or neck. Seven patients had a neurological deficit without pain, nineteen had so-called mechanical or arthritic pain, nine had pain that was attributable to the Paget lesion, and ten had a combination of the two types of pain. The most common cause of the spinal stenosis was expansion of bone that led to compression of the thecal sac and its neural elements. In one patient, the cord was compromised further by a pathological fracture of the eighth thoracic vertebra. There was a strong correlation between the presence of symptoms and the findings of spinal stenosis and arthropathy of the facets (zygapophyseal joints) on computed tomography. The spinal stenosis and the arthropathy of the facets were caused by the abnormal, hyperactive bone-remodeling, which resulted in the expansion of the osseous elements of the involved vertebra or vertebrae.

Aged↗
PubMed1991

Pseudonotch of the atlas vertebra simulating fracture with computed tomographic diagnosis. A case report.

Pseudonotch of the atlas represents a normal variation of the atlas related to a notched protuberance of the medial surface of its lateral masses. A case is presented in which cervical spine roentgenography revealed a prominent pseudonotch that mimicked a fracture of the lateral masses of the atlas. Minimal rotation of C-1 on C-2 was present without apophyseal joint subluxation. Computed tomography imaging provided an accurate diagnosis.

Adult↗
PubMed1987

Allografts in orthopedic surgery: a case report and literature review.

Recent advances in orthopedic surgery have reawakened interest in the use of osteochondral allografts. A case is presented of a 32-year-old man who was spared a hemipelvectomy for a huge chondrosarcoma of the pelvis by receiving a massive pelvic allograft. This is apparently the first report of such a procedure being performed in Canada. A history of allografting as well as the fate and immunologic aspects of bone grafts are presented. Bone-banking procedures and the clinical application of allografts in 1986 are discussed.

Adult↗
PubMed1986

Pagetic arthritis. Pathophysiology and management.

A review of the records of 112 patients demonstrate modern concepts of pathogenesis and treatment of Paget's disease. Pain from Pagetic arthritis should initially be treated by medical treatment aimed at modulation of bone blood flow. Patients, even with impressive arthritic reactions, can respond dramatically. Pain persists in patients with end-stage destruction of articular cartilage and/or stress microfractures. Patients with deformity without joint space loss may be candidates for osteotomy. Advanced cartilage destruction is treated by total arthroplasty and continuation of anti-Pagetic therapy after surgery, possibly to reduce the incidence of component loosening. Articular cartilage erosion and subchondral bone destruction are attributable to the disease process. Vascular invasion and joint surface collapse are associated with cartilage thinning and sequestration.

Arthritis↗
PubMed1985

Soft-tissue chondromas.

Soft-tissue chondromas are benign, relatively rare lesions. The clinicopathologic and radiologic features in six cases are presented and the literature is reviewed. Five of six cases had calcifications. Peripheral curvilinear calcification was seen in two cases, multiple ringlike areas characteristic of cartilage in one, and discrete ossification in another. Histopathologically, they were diverse, ranging from an immature pattern with a preponderance of chondroblasts to a more mature form with chondrocytes. Although these lesions resemble a wide variety of other soft-tissue lesions, they can usually be differentiated by their small size, characteristic location in the extremities, the nature of their calcifications, and the histopathologic features. The importance of this lesion is that it is benign. It must be distinguished from more aggressive soft-tissue neoplasms such as soft-tissue chondrosarcoma so as to spare the patient unnecessary radical therapy.

Adolescent↗
PubMed1983

Difficulty of diagnosing infected hypertrophic pseudarthrosis by radionuclide imaging.

Hypertrophic pseudarthrosis was studied with Tc-99m MDP and Ga-67 citrate in 11 patients. Two of the 11 pseudarthroses were complicated by infection. A high concentration of both radiopharmaceuticals was obtained at all 11 sites and their distribution patterns were identical. It was therefore impossible to distinguish the infected from the noninfected pseudarthroses by using Ga-67.

Bacterial Infections↗