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Biomedical subjects

D I Rosenthal

Publications and source records attributed to D I Rosenthal.

At least 19 recordsLinked to original sources
PubMed1992

Percutaneous needle biopsy of the spine.

The results of 75 percutaneous needle biopsies of the spine were analyzed. There were 8 cervical, 25 thoracic, 27 lumbar, and 15 sacral biopsies. An accurate diagnosis was made in 92% of all cases. Metastatic disease yielded the best accuracy rate (96%). The lowest accuracy rate (82%) was noted with benign primary tumors and fractures. The results were better in female patients than male (97% vs. 86%). Larger needles gave slightly better accuracy (97%). No relationship between accuracy and spine level was found. There were two complications: one pneumothorax and an episode of self-limited hemorrhage. Percutaneous needle biopsy is a safe and reliable method of obtaining a diagnosis in many different spine lesions.

Adolescent↗
PubMed1992

Quantitative chemical shift imaging of vertebral bone marrow in patients with Gaucher disease.

To evaluate extent of bone marrow involvement and disease severity in Gaucher patients, results of modified Dixon quantitative chemical shift imaging (QCSI) of the lumbar spine were correlated with quantitative analysis of marrow triglycerides and glucocerebrosides and with quantitative determination of splenic volume at magnetic resonance (MR) imaging. High-field-strength MR spectra of surgical marrow specimens were dominated by a single fat and a water peak, validating use of QCSI. QCSI showed average vertebral marrow fat fractions of 10% +/- 8 in Gaucher patients (normal adult averages, 29% +/- 6). Relaxation times for lipid and water approximated normal averages; bulk T1 values were significantly longer, reflecting decreased marrow fat. Glucocerebroside concentrations were higher in Gaucher marrow and inversely correlated with triglyceride concentrations. Extent of marrow infiltration determined by fat fraction measurements correlated with disease severity measured by splenic enlargement. These results show that as Gaucher cells infiltrate bone marrow and displace normal marrow adipocytes, bulk T1 increases due to the higher T1 of water compared with that of fat. QCSI provides a sensitive, noninvasive technique for evaluating bone marrow involvement in Gaucher disease.

Body Water↗
PubMed1992

Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure.

Osteoid osteoma is a benign, self-limited tumor of bone that usually requires surgical excision for relief of pain and to prevent long-term consequences. Radio-frequency electrodes have been successfully and safely used to ablate small areas of the central nervous system and to perform ablation elsewhere in the body. The authors have used this technique in four patients with proved or presumptive osteoid osteoma, completely relieving the symptoms in three.

Adult↗
PubMed1992

Quantitative imaging of Gaucher disease.

Twenty-three patients with type 1 Gaucher disease were evaluated with a battery of quantitative imaging techniques. Plain radiographs were used to measure cortical thickness and Erlenmeyer flask deformity. Xenon-133 uptake was measured in scans of the lower extremities. Dual-energy quantitative computed tomography was used for calculation of trabecular bone and bone marrow fat content in the spine and long bones. Magnetic resonance (MR) imaging was performed to evaluate disease extent and three-dimensional splenic volume. MR images were also used to provide quantitative measurements of each vertebral fat fraction. Each imaging modality was correlated with the others as well as with the clinical history of skeletal complications and the hematocrit and acid phosphatase activity. There was a strong relationship between splenic volume and disease severity as measured clinically and with laboratory testing. The spinal fat fraction also correlated with these measures of disease severity and with the femoral fat fraction and xenon uptake. No measurement allowed discrimination of patients with from those without skeletal complications.

Adolescent↗
PubMed1992

Progressive trabecular osteopenia in women with hyperprolactinemic amenorrhea.

Reductions in cortical and trabecular bone mass have been documented in young women with hyperprolactinemic amenorrhea. It is unknown whether trabecular osteopenia is progressive or reversible with treatment of hyperprolactinemia. In addition, it is not known whether clinical or hormonal variables can predict trabecular bone density (BD) changes. Therefore, we investigated prospectively trabecular BD by computed tomography in 52 hyperprolactinemic women and 41 controls. The mean follow-up interval was 1.8 +/- 0.1 (SEM) yr. Patient groups were defined as follows: group 1, amenorrhea during the entire study; group 2, restoration of menses during the study by treatment of hyperprolactinemia; group 3, regular menses despite hyperprolactinemia, with no history of prior amenorrhea; group 4, history of prior amenorrhea, but menses restored with treatment of hyperprolactinemia before study entry; and group 5, oligomenorrhea. Groups 1, 2, and 4 had significant (P = 0.0006) initial spinal osteopenia [mean BD 141 +/- 7 (SEM), 144 +/- 9, and 151 +/- 5 mg/cc K2HPO4, respectively] compared with controls or with group 3 (170 +/- 4 and 173 +/- 8 mg/cc K2HPO4, respectively). Group 5 had an initial mean BD which was midway between that of the amenorrheic and eumenorrheic women (156 +/- 13 mg/cc K2HPO4). Group 1 had a significant (P = 0.04) decrease in mean BD to 132 +/- 8 mg/cc K2HPO4 over 1.7 +/- 0.2 yr, with BD in 42% of the group more than 2 SD below the control mean at the final study point. The mean BD in group 2 increased to 155 +/- 9 mg/cc K2HPO4, approaching significance (P = 0.07) when compared with the initial BD. Five of the nine patients in this group (56%) had an increase in BD greater than the variation expected for the computed tomography technique. However, 44% of the group 2 patients had a spinal BD which remained more than 1 SD below the normal mean. There was no change in BD in the other groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Skin reactions to radiotherapy--a spectrum resembling erythema multiforme: case report and review of the literature.

Eruptions resembling erythema multiforme associated with radiotherapy are rare. Although several case reports are cited in the older literature, only recently has this phenomenon been described in patients receiving external beam radiation therapy both with and without contributory concurrent medications. The eruption typically begins within the radiation port and then generalizes; it is usually self-limited, but serious and fatal outcomes are reported. We review the literature and report a case of an eruption resembling erythema multiforme associated with external beam irradiation and 5-fluorouracil.

Adenocarcinoma↗
PubMed1991

Percutaneous biopsy of skeletal lesions.

Percutaneous needle biopsy of lesions affecting the musculoskeletal system should be considered a routine radiologic procedure. Although relatively safe, the procedure requires expertise. An experienced radiologist and the cooperation of a skilled pathologist are essential. Consultation with the orthopedic surgeon is also important, especially when resection of the lesion is contemplated. Recent advances in imaging techniques and the availability of various cutting and trephine needles have made it easier to perform biopsies safely and accurately, even in difficult locations. The procedure obviates surgery in many instances and facilitates appropriate surgical planning in others. This review offers a pragmatic approach to percutaneous needle biopsy of skeletal lesions. It is hoped that more radiologists will be encouraged to undertake these valuable procedures.

Biopsy, Needle↗
PubMed1991

Radiographic appearance of osteopenia.

The radiographic appearance of bone is the result of two physiologic processes: the resorption of bone and the remodeling of bone in response to the stresses applied to it. The relative rates of these two processes will determine the structural and, therefore, the radiographic appearance of the affected bone.

Adult↗
PubMed1991

Arthrography of the hand and wrist.

Arthrography of the wrist and hand is easy to perform, but accurate diagnosis requires meticulous technique and thorough knowledge of anatomy, pathology, and imaging principles. Wrist arthrography is usually performed to assess pain or instability after trauma; a complete examination usually requires injection of the RC, midcarpal, and distal radioulnar joints. Abnormalities that can be detected include interosseous ligament tears, capsular tears, triangular fibrocartilage perforations and separations, cartilaginous defects, loose bodies, and synovial abnormalities including adhesive capsulitis. Arthrography can also be useful in the evaluation of masses and scaphoid nonunion. Finger arthrography can demonstrate capsular injury, ligament tears, tendon derangement, volar plate disruption, cartilage abnormalities, fibrous ankylosis, synovial abnormalities, and ganglia. Tenography is seldom performed; this technique can delineate synovial abnormalities and can be used to evaluate tendon subluxation.

Arthrography↗
PubMed1990

Cost effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy.

Bone mass measurement at menopause to identify and selectively prescribe hormone replacement therapy for women at high risk for fractures has seen limited clinical use. We used epidemiologic, clinical, and economic data in a decision-analytic model to compare the following clinical strategies for perimenopausal, asymptomatic, white women with intact uteri: no intervention; bone mineral density measurement followed by selective, long-term (15-year) estrogen-progestin therapy in women with low bone mass; and unselective, universal hormone replacement therapy. Life expectancy and direct medical cost per patient were estimated for each strategy. Strategies for screening and treating women with perimenopausal bone mineral density less than 0.9 g/cm2 or less than 1.0 g/cm2 would cost $11,700 or $22,100, respectively, per year of additional life gained. If the cost of screening is less than $84, then resource savings from hip fractures prevented would be more than the cost of screening and treatment. Universal treatment without screening would prevent additional fatal fractures but would expose many more women to the adverse effects of hormone replacement therapy and would cost an additional $349,000 per year of life gained compared with the screening strategies. When quality of life was considered, screening was found to be cost effective over a wide range of assumptions. The choice between universal treatment and screening depends on the risks (breast cancer), perceived side effects (menstrual bleeding), and benefits (prevention of ischemic heart disease) of estrogen-progestin therapy. We conclude that screening asymptomatic, perimenopausal white women to detect low bone mass and to target hormone replacement therapy at women who are at the greatest risk for fracture is a reasonably cost-effective use of health care resources. However, cost-effective screening guidelines cannot be explicitly established until further data addressing the association between bone mass measurements in the hip and hip fracture risk are available.

Aged↗
PubMed1990

Magnetic susceptibility effects of trabecular bone on magnetic resonance imaging of bone marrow.

High-field spectroscopic studies at 5.88 tesla (T) indicate significant T2* shortening of water in suspensions of powdered bone, interpreted to be a result of magnetic susceptibility differences between bone particles and water. The authors investigated the effects of magnetic susceptibility differences between trabecular bone and water on magnetic resonance (MR) images at 0.6 T. The phantom was constructed of macerated intact trabecular human bone immersed in water. Although susceptibility-induced magnetic field inhomogeneities were detected by spectral line broadening by using an asymmetric spin-echo technique, the results show only a modest T2* shortening at this field strength. As expected, no T1 effect of trabecular bone was observed. Although susceptibility effects of trabecular bone may have a small impact on the signal intensity of MR images of bone marrow at midfield strength, the observed field strength dependence of these effects would predict significant susceptibility effects on clinical images at higher field strength.

Bone Marrow↗
PubMed1990

Porous-coated anatomic total hip prostheses: radiographic analysis and clinical correlation.

The radiographic changes of 46 bone-ingrowth, porous-coated anatomic total hip prostheses were reviewed and compared to the clinical outcome. The average postoperative follow-up was 32 months. The radiographic features that were assessed included subsidence; periprosthetic lucencies; periosteal, endosteal, and heterotopic new bone; loose beads; implant position; and tightness of fit. Clinical results were based on the Harris hip score. All acetabular components fared well. Three of the femoral stem components needed revision. The radiographic finding that correlated best with outcome was subsidence of more than 10 mm, especially if it continued to increase more than 1 year after surgery. Other findings related to failure were loosely placed femoral stems and the presence of loose beads. However, subsidence was such a powerful predictor of clinical outcome, and the other features were so weak, that combinations of variables did not improve the assessment of outcome. Close attention should be paid to subsidence in follow-up studies.

Chromium Alloys↗
PubMed1990

Metronidazole in head and neck surgery--the effect of lengthened prophylaxis.

Previous studies of antibiotic prophylaxis have shown that treatment for 24 hours has been beneficial for head and neck surgery and that longer periods of antibiotic therapy have not improved results. Metronidazole (Flagyl), unlike other antibiotics tested, has been shown to be effective in an experimental abscess, even if treatment is begun up to 120 hours after administration of inoculum. This article presents a prospective, randomized, multifactorial study comparing a brief vs. a prolonged duration of metronidazole and cefazolin prophylaxis in 50 consecutive patients with a head and neck cancer undergoing operation. Patients receiving 2 days vs. 7 or more days of antibiotic prophylaxis were compared. Statistical analysis of data demonstrated a striking reduction in severity of wound complications and a reduced incidence of wound infections in the group treated with 7 or more days of antibiotic prophylaxis.

Adult↗
PubMed1989

Age and bone mass in premenopausal women.

It is important to determine the bone mass in normal premenopausal women because increasing numbers of conditions have been identified that result in premenopausal osteoporosis. The relationship between age and bone density was evaluated in 57 carefully characterized normal, premenopausal women using both single energy quantitative computed tomography (SEQCT) and dual energy (DEQCT). The mean bone density measurements were 172 mg/ml K2HPO4 SEQCT and 185 DEQCT. Bone density showed no statistically significant decline between age 18 and age 44. Single- and dual-energy data were highly correlated with each other (r = 0.89), and dual energy appeared to confer no advantage. There was an inverse relation between density and age of menarche. Bone density did not correlate with ideal body weight, percentage fat, or subcutaneous fat area.

Adolescent↗
PubMed1989

Controlled thermal injury of bone. Report of a percutaneous technique using radiofrequency electrode and generator.

Percutaneous ablation of the trigeminal ganglion using radiofrequency energy is an accepted treatment for trigeminal neuralgia. To test the applicability of this system to the percutaneous ablation of bone neoplasms, the authors studied its effects in the normal femurs of four living dogs. Lesions were made of various duration and spaced over time to determine the extent of injury and the natural history of healing. Bone and bone marrow necrosis was limited to a sphere approximately 1 cm in diameter, regardless of the probe size or duration of heating. No complications were encountered. This technique may be useful in the treatment of certain benign neoplasms of bone that are otherwise resected.

Animals↗
PubMed1989

Bone and bone marrow changes in Gaucher disease: evaluation with quantitative CT.

The trabecular bone density and bone marrow fat content in eight patients with type 1 Gaucher disease were measured with the use of a modification of dual-energy computed tomography (CT). The results were compared with those in published reports of single-energy quantitative CT measurements in healthy subjects and with dual-energy data obtained in studies of healthy premenopausal women and elderly osteopenic women. The trabecular bone mass was moderately decreased in patients with Gaucher disease. The bone marrow fat content was markedly diminished, presumably due to replacement of marrow fat by Gaucher cells. In healthy and osteopenic subjects single-energy quantitative CT values were lowered by the presence of marrow fat. Comparable single-energy measurements in patients with Gaucher disease reflect greater degrees of bone loss. Low levels of marrow fat may prove to be a valuable marker of the severity of marrow disease.

Absorptiometry, Photon↗