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Biomedical subjects

D Uyttendaele

Publications and source records attributed to D Uyttendaele.

At least 19 recordsLinked to original sources
PubMed2002

[Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus].

PURPOSE OF THE STUDY: Treatment of primary bone tumors of the proximal humerus is a major challenge, both in terms of oncological cure and limitation of functional handicap. Extracorporal radiation and reimplantation have provided satisfactory results for the treatment of bone tumors and the inverted shoulder prosthesis has be found to be effective in treating rotator cuff deficiency. We therefore assessed patients treated with a combination of these two treatments in order to search for a better functional outcome. MATERIAL AND METHODS: Conservative resection of the tumor with reconstruction using an inverted shoulder prosthesis was performed in six patients with a tumor of the proximal humerus of type Ia or Ib in the Malawer classification or type S3-S4-S5 in the Musculoskeletal Tumor Society classification. Patients whose tumor involved the deltoid or the glenohumeral joint were not considered for this procedure. The series included four men and two women (4 left and 2 right shoulders) aged 51 years on the average at the time of surgery. RESULTS: Mean follow-up was 12 months. The mean age- and sex-adjusted Constant score was 74% (70-85%). The patients were generally satisfied and were able to continue their daily activities. There were two displacements, one of which was diagnosed immediately and reduced without anesthesia. An abduction pad was worn for six months after reduction. The post-operative period was uneventful. No local recurrence has been observed. DISCUSSION: Our results compared favorably with other therapeutic options for resection-reconstruction reported in the literature: functional outcome was better and more predictable, at least in the short term; oncological results were satisfactory although the follow-up is short, particularly for the three primary malignant tumors. It is known however that the long-term oncology result depends on the quality of the resection and the efficacy of the extracorporeal radiation. Shoulder motion outcome was the least satisfactory in patients who experienced peri-operative complications. We were unable to find any relation between less satisfactory functional outcome and the number of surgical procedures for local recurrence before extracorporeal radiation and arthroplasty (deltoid dystrophy). Normal deltoid function appeared to be crucial for optimal functional outcome with this prosthesis which allows sacrifice of the rotators. The rate of complications was low and recovery of active shoulder movement was more rapid. Despite the short-term nature of these results, and despite the risk of loosening, the inverted shoulder prosthesis appears to be an interesting therapeutic option for these patients.

Activities of Daily Living↗
PubMed2001

Neurofibromatosis, gigantism, elephantiasis neuromatosa and recurrent massive subperiosteal hematoma: a new case report and review of 7 case reports from the literature.

The authors report the case of a 13-year-old patient with neurofibromatosis (NF-I), who suffered blunt trauma to the left tibia in 1993. The diagnosis of subperiosteal hematoma was made. Treatment consisted of temporary rest. There was a recurrence in 1996, and the subperiosteal hematoma was drained. In 1997, a shortening osteotomy of the left tibia was performed. However, massive gigantism with elephantiasis of the left leg remained, causing a serious functional and cosmetic problem. In 1999, the leg was amputated above the knee. The literature is reviewed and 7 case reports are compared. The pathogenesis of subperiosteal hematoma is discussed.

Adolescent↗
PubMed2001

Parosteal osteosarcoma of the humerus.

The authors report the case of a 50-year-old man who presented with nontraumatic swelling of the left upper arm. The diagnosis of parosteal osteosarcoma of the humerus was made after diagnostic workup. A long diaphyseal segment of the humerus containing the tumor was resected with a healthy margin of soft tissues and was irradiated extracorporeally with a single dose of 30 Gray. The bony segment was then reimplanted after removal of the tumor using plate and screw fixation. Loosening of the proximal screws after one year required additional fixation and autologous cancellous bone grafting. The patient has a nearly three-year-follow-up and there are no signs of tumor recurrence or metastasis. The proximal osteotomy has healed nicely; the distal fixation osteotomy exhibits delayed healing. The pathogenesis of parosteal osteosarcoma is discussed.

Bone Neoplasms↗
PubMed1998

Examination of the back using the Bunnell scoliometer in a Belgian school population around puberty.

The present study was designed to determine whether quantified clinical measurement of the back would provide arguments supporting a biomechanical cause of adolescent idiopathic scoliosis (AIS). Two hundred ninety-two healthy girls (9 to 16 years) and 191 healthy boys (11 to 18 years) were examined clinically with the use of the Bunnell scoliometer. The inter- and intraobserver measurement error was determined. The accuracy of the Bunnell scoliometer as a biomorphological measurement method is good (variation coefficient +/- 10%). The measurement error is not influenced by the site of the rib hump or the type of scoliosis, but by the magnitude of the deformity to be measured. The present study confirms that the threshold for differentiating a physiological from a pathological gibbosity is 5 degrees C, as advanced by Bunnell (1984). The Bunnell measurement shows no statistically significant differences between boys and girls, although the standard deviation of the measurement in the declive segment is larger in girls. In all spinal segments measured, the scoliometer values show the same evolution in the boys and girls of the various age groups. Although the larger standard deviation in the declive segment in girls favors the existence of a physiological scoliosis, the present study shows no evolution in the various spinal segments for the age groups studied, and therefore does not substantiate the biomechanical etiopathogenic theories for the development of AIS.

Adolescent↗
PubMed1998

Technetium-99m-MDP scintigraphy and long-term follow-up of treated primary malignant bone tumors.

UNLABELLED: Local malignant bone tumor excision followed by high-dose extracorporeal irradiation (300 Gy) and subsequent reimplantation is a unique technique for treatment of primary bone and cartilage tumors. The long-term scintigraphic findings of irradiated bone autografts in relation to clinical patient data were reviewed retrospectively. METHODS: Thirty-seven patients (12 women, 25 men; age range 13.0-66.7 yr; average age 29.1 yr) were studied. Postsurgical anatomopathological diagnoses included osteosarcoma, 20 patients; chondrosarcoma, 7 patients; and other less-frequent primary osteogenic tumors, 10 patients. Three hundred ninety 99mTc-methylene diphosphonate (MDP) whole-body scans performed between 3 mo and 18.3 yr (mean 6.5 yr) after treatment were reviewed. RESULTS: The 10-yr actuarial survival rate was 78%. After a mean period of 19.4 mo, 6 patients developed a local recurrence, and MDP scintigraphy detected the recurrence in 4. Distant metastases developed in 11 patients (30%), of which 10 were nonosseous. Initially, all autografts appeared as photon-deficient areas. Diffusely increased bone uptake was present at osteotomy sites and at articulating surfaces contiguous with autografts within the first few months after surgery. Of all 25 patients with adequate follow-up, 7 showed persistent decreased uptake up to 129 mo after surgery. The other patients developed partial tracer uptake after 19.6 mo, on average. In 6 patients, scintigraphic images consistent with complete revascularisation were noted later (mean 31.5 mo). Local, sometimes multiple, complications were noted in 22 patients, mainly mechanical graft-related (15) or infections (11). Scintigraphic sensitivity for mechanical complications was 100%. Significantly more fractures and collapses were seen when partial tracer uptake suggestive of revascularisation occurred. Altered bone stress gave rise to focal and diffuse scintigraphic abnormalities, often in the spine and lower extremities. In recent literature, similar clinical complication patterns are found for massive allografts. CONCLUSION: Skeletal scintigraphy is a sensitive technique for evaluating long-term follow-up of massive grafts to treat primary malignant bone tumors. Revascularisation and partial bone ingrowth are not sufficient conditions for a lower complication rate.

Adult↗
PubMed1996

Intramedullary fixation of forearm fractures in adults.

The authors present a retrospective study of acute fractures of the diaphysis of the radius or ulna, or both, in adults treated by intramedullary nailing. Seventy diaphyseal fractures in 38 patients (30 men and 8 women) were treated by intramedullary fixation. The mean age of the patients was 31.5 years. Union occurred in 66 fractures (94%). The average union-time was 73 days. Compared with the results published by other authors, using the same evaluation criteria, union-time with the intramedullary technique was shorter than with other techniques. Union-rates and functional results were similar to those in comparable studies. Closed nailing does have many advantages, including early union, low incidence of infection, small scars, less blood loss, and short operating time with minimal surgical trauma.

Adolescent↗
PubMed1995

Static, dynamic and first-pass MR imaging of musculoskeletal lesions using gadodiamide injection.

Forty-five patients with known or suspected musculoskeletal tumors were examined with static and dynamic MR imaging to evaluate the safety, tolerability and diagnostic utility of gadodiamide injection and to assess the diagnostic value of dynamic MR imaging and parametric "first-pass" (FP) images. The proportion of patients presenting more diagnostic information on the contrast-enhanced compared to the precontrast spin-echo examinations was determined. The dynamic enhancement characteristics were evaluated with time-intensity curves and parametric images of the FP enhancement rate. The tolerance of gadodiamide injection was good. Contrast enhancement was useful for delineating tumor from muscle, and differentiating viable from necrotic tissue and cystic from solid lesions. Malignant tumors showed a significantly higher slope value, earlier onset of enhancement, and higher maximum enhancement than benign lesions. However, slope values could not be used to predict the malignant potential of a lesion, due to overlap between highly vascular benign and low vascular malignant lesions. By displaying highly vascular areas, parametric FP images provided useful information on the most active part in a tumor before biopsy and for assessing the incorporation of bone-chip allografts. Static, dynamic and FP MR imaging using gadodiamide injection appears safe and provides useful information for diagnosis, biopsy and follow-up of musculoskeletal lesions.

Adult↗
PubMed1995

Thallium-201 accumulation in myositis ossificans and in juxta-articular ossification.

We present the findings on 201Tl and 99mTc-MDP scintigraphy in three patients suffering from heterotopic ossification (two patients presenting with myositis ossificans and one patient presenting with juxta-articular ossification in combination with myositis ossificans). Since resection of the lesions has to be delayed until stabilization, 99mTc-MDP is often used as a parameter of lesional activity, although it is not optimal. For this clinical problem, we evaluated 201Tl scintigraphy as a marker of metabolic activity. In addition to the well-documented uptake of 99mTc-MDP, marked accumulation of 201Tl was observed in all heterotopic ossification sites. Hence, our results support the use of 201Tl scintigraphy in the therapeutic management and monitoring of conditions associated with ectopic ossification. On the other hand, although myositis ossificans is sometimes clinically, radiographically and even histologically confused with extraosseous osteogenic sarcoma, 201Tl accumulation may not be a helpful factor in the differential diagnosis due to the presence of tracer accumulation in both disorders.

Adult↗
PubMed1994

First-pass images of musculoskeletal lesions: a new and useful diagnostic application of dynamic contrast-enhanced MRI.

The purpose of this study was to evaluate the diagnostic value of parametric images which display the first-pass of Gd-DTPA after intravenous bolus injection. Single slice dynamic contrast-enhanced MRI (Turbo-FLASH) with a temporal resolution of 2.41 s was performed in 40 benign and malignant musculoskeletal lesions. Parametric 'first-pass' images were obtained by using a new postprocessing technique, derived from a home written computer program, which calculated the steepest slope of the time-intensity curve pixel by pixel. First-pass images provided qualitative and quantitative information, which was useful for diagnosis and therapy. Demonstration of the areas with the highest vascularization was very helpful in planning the best biopsy site in 6 patients and to delineate tumor from peritumoral muscle edema in 4 patients. In 10 patients the first-pass images provided additional information, which was not visible on the conventional spin-echo images. The most promising application was the ability to evaluate the response to preoperative chemotherapy in a patient with Ewing's sarcoma. Although a highly statistically significant difference (p < 0.001) was found between the first-pass slope values of benign and malignant lesions, the sensitivity (77%) and specificity (71%) of this method were too low to permit a definite differentiation of highly vascular benign from malignant lesions. Pathologic examination of 17 lesions, performed in the plane of the first-pass image, showed a good correlation between the first-pass slope values and the vascularization of the tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging--parametric "first-pass" images depict tissue vascularization and perfusion.

PURPOSE: To assess the diagnostic value of parametric magnetic resonance images that display the first pass (FP) of gadopentetate dimeglumine. MATERIALS AND METHODS: Dynamic, contrast material-enhanced, fast low-angle shot MR imaging was performed of 100 musculoskeletal lesions in 36 female and 64 male patients (aged 9-81 years [mean, 34 years]). The highest slope value of the time-intensity curve was calculated pixel by pixel and displayed on the FP image, with a gray-scale value equal to the slope value. Tissue vascularization and perfusion were evaluated at pathologic and angiographic examinations in 33 lesions. RESULTS: A significant difference (P < .001) was found between the FP slope values of benign (mean, 36.2% per second) and malignant (mean, 67.4% per second) lesions. FP images depicted tissue vascularization and perfusion rather than benignity or malignancy, because there is an overlap in the slope values of highly vascular benign lesions and malignant lesions. CONCLUSION: FP images provide diagnostically useful information by depicting tissue vascularization and perfusion.

Adolescent↗
PubMed1994

Treatment of unstable fractures, dislocations and fracture-dislocations of the cervical spine with Senegas plate fixation.

The results of the anterior approach to the cervical spine for the treatment of fractures and dislocations by arthrodesis and Senegas plate fixation are described. Twenty-two patients underwent a one- or two-level arthrodesis of the cervical spine. Their mean age was 42 years. The injuries were subdivided using the radiological classification described by Harris. In the group of patients who presented with a complete neurological deficit below the level of injury, there was only one patient who deteriorated. X ray examination 1 year after surgery showed fusion in 17 patients (100%). In contrast to some recent cadaveric and animal studies in which the anterior approach and fixation were found to be less stable than posterior fusion, our results obtained with this method are excellent, despite the fact that post-operative immobilization was limited. Problems with the anterior approach did not arise in these 22 patients. Alignment was always acceptable and fusion was achieved within one year in all cases.

Adolescent↗
PubMed1992

Molecular cytogenetic analysis of a complex t(10;22;11) translocation in Ewing's sarcoma.

Fluorescence in situ hybridization (FISH) using chromosome-specific plasmid libraries and chromosome region-specific DNA markers allowed the characterization of a t(10;22;11) (p11.2;q12;q24) in a Ewing's sarcoma (ES). This study illustrates the usefulness of molecular cytogenetic analysis of ES, especially for determining the localization of the translocated 11q24-25 segment in complex or variant translocations.

Adult↗
PubMed1992

Spinal cord monitoring. State of the art. Results in Harrington and C.D. instrumentation for scoliosis.

In scoliosis surgery, it is of paramount importance to obtain extensive correction of the curve without compromising the integrity of the spinal cord. Up to now, the wake-up test has been used for the intra-operative assessment of spinal cord function. Besides the fact that the test only provides a single evaluation, it is also encumbered with some potential hazards related to the anesthetic procedure. An additional problem arises when the technique is applied in psychiatric patients. An alternative approach is the continuous recording of evoked potentials obtained from sensory stimulation. The method permits uninterrupted intra-operative monitoring of the neurological status of the cord.

Adolescent↗
PubMed1992

Kashin-Beck's disease.

A case of Kashin-Beck's disease is presented. It is an acquired, disabling, polyarthritic, degenerative condition of early onset, sometimes leading to a variable degree of dwarfism. It occurs endemically in certain Asian areas. Treatment is, if possible, preventive. In the established disease the therapy is that of any other form of secondary osteoarthritis. Reconstructive surgery and removal of loose bodies may be needed in severe cases (11). Early detection, facilitated by careful family history taking, is a prime requisite, especially in non-endemic areas (7).

Ankle↗
PubMed1991

Occipito-cervical fusion in rheumatoid arthritis.

Between 1977 and 1988 twenty-five patients with rheumatoid arthritis involving the cervical spine were treated by an occipito-cervical fusion. Twenty-two patients are included in this study. The main indications for surgery were intractable pain and progressive neural impairment. The operative procedure consisted of an H-bone graft fixed with steel wire in 19 cases, fusion of occiput-C2 six times and of occiput-C3 thirteen times. A Hartshill-Ransford (5, 12) loop was used in three cases: occiput-C3 twice and occiput-C7 once. The mean duration of follow-up was 3 years 8 months in 17 patients. Improvement of symptoms and signs was achieved in 88%. There were 2 post-operative deaths. The high rate of pseudarthrosis in our series was confirmed by several authors. The loop technique provides a more stable fixation and will be our technique of choice in the future.

Adult↗
PubMed1990

Surgical treatment of tibial pseudarthrosis using the Ilizarov apparatus. A critical analysis.

Since November 1985 the authors have added the Ilizarov procedure to their armamentarium for the treatment of tibial pseudarthrosis. The results of a first clinical study of 10 patients are reported. The mean duration of follow-up is 17 months. The consolidation rate is higher with a transverse than with an oblique pseudarthrosis. The Ilizarov procedure combined with a corticotomy offers new perspectives in the management of massive bone defects. In the presence of severe malalignment, a gradual reduction can be carried out. The main complications are pin tract infections and algodystrophy.

External Fixators↗
PubMed1990

Treatment of the irreducible hip.

"Irreducible" congenital dislocation of the hip should not be regarded as a special pathological entity. Thirty-eight cases with a previous and failed treatment attempt were reviewed. Recognition of the renal cause of "irreducibility" (iatrogenic or anatomopathological) and institution of an appropriate treatment protocol result in adequate reduction in the vast majority of cases. However, osteochondritis is not an uncommon finding when the results of secondary treatment are evaluated. The percentage of more severe cases is higher after open procedures.

Hip Dislocation, Congenital↗