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Biomedical subjects

Douglas P Beall

Publications and source records attributed to Douglas P Beall.

At least 19 recordsLinked to original sources
PubMed2007

Contrast reaction from hip arthrogram.

Arthrography is considered a safe procedure with rare reactions to intra-articular contrast administration. Although the use of intra-articular contrast carries a small risk of reaction, no prior serious complications had been encountered in our experience with arthrography. We report a patient's prolonged reaction to contrast media after an arthrogram of the hip. Literature review demonstrated no prior report of contrast media reactions to hip arthrography. Therefore, we decided to review the literature and report our case.

Arthrography↗
PubMed2007

Transoral vertebral augmentation with polymethylmethacrylate in the treatment of a patient with a dens fracture nonunion and subarticular vertebral body fracture of C2.

The injection of polymethylmethacrylate (PMMA) is a minimally invasive, image-guided procedure used to treat vertebral fractures due to osteoporosis, metastatic lesions, multiple myeloma, and benign but destabilizing bone tumors. The injection of PMMA into the C2 vertebral body using the transoral technique has been reported in three separate patients for treatment of benign tumors (a vertebral hemangioma and an aneurysmal bone cyst) and for multiple myeloma in the third patient. Although the injection of PMMA into the vertebral body is most commonly performed to treat benign vertebral compression fractures, a transoral C2 approach has not been reported in the English literature as a treatment for a benign fracture of C2. We report the treatment of a fracture and nonunion of the base of the dens and a subarticular fracture of the vertebral body of C2 using a bilateral transoral approach.

Aged, 80 and over↗
PubMed2006

Technical strategies and anatomic considerations for parapedicular access to thoracic and lumbar vertebral bodies.

OBJECTIVES: To investigate and illustrate a variation on the traditional percutaneous access to the vertebral body via a parapedicular approach. DESIGN: An effective parapedicular access technique that could safely and reliably guide the needle tip into the center of the vertebral body was developed from cadaver dissection observations for the purpose of clinical use. PATIENTS: A total of 102 vertebral compression fractures from T-4 to L-5 were treated via the parapedicular access at our institution between July 2005 and March 2006. There were 72 patients between the ages of 17 and 96 years (mean age: 68.2 years) who underwent treatment. RESULTS: The cadaver dissection revealed a relatively avascular and aneural portion of the vertebral body along the superior margin of the vertebral body-pedicle junction. A total 102 vertebral fractures were treated using the parapedicular access technique without any recognized clinical complications from the needle access or the instrumentation. CONCLUSIONS: The thoracic and lumbar vertebral bodies may be safely, reliably, and reproducibly accessed using a percutaneous parapedicular access technique. The technique presented represents a relatively avascular and aneural approach to vertebral body.

Adolescent↗
PubMed2006

Clinical examination of the athletic hip.

This article provides a succinct and complete method for the clinical evaluation of the hip. Included are descriptions of examination tests as well as their relationships to possible pathology of the hip. The examination is divided into five stages: seated, standing, supine, lateral, and prone; with a total of 11 assessment points. The method for evaluation outlined will assist physicians in determining the location and etiology of presenting hip pathologies. As with any examination, practice and repetition are essential to gain an appreciation of what constitutes a normal as well as an abnormal examination.

Adult↗
PubMed2006

Postoperative imaging of the hip.

The number and type of operative procedures involving the hip continue to increase, placing a greater emphasis on characterizing patient postoperative condition accurately. Optimal postoperative imaging evaluation may involve multiple modalities, including conventional radiography, radionuclide scintigraphy, and cross-sectional imaging. Many of the surgical procedures involve the placement of metallic joint replacements or fixation that can make the imaging evaluation of the postoperative anatomy challenging. Clinical examination of patients combined with the type of procedure performed direct the appropriate imaging evaluation; adequate clinical knowledge of these procedures and how to optimally image them provide an opportunity to attain the most accurate evaluation possible.

Arthrography↗
PubMed2006

Magnetic resonance imaging of the rotator cuff interval.

The rotator cuff interval (RCI) is an important and anatomically complex region of the rotator cuff that is critically important to normal glenohumeral function. Recognition of common pathologies in this region on imaging examinations is especially important as injuries may be difficult to detect on clinical examination and even at arthroscopy. Familiarity with the magnetic resonance imaging appearance of the normal and abnormal RCI and the ability to convey findings to orthopedic and sports medicine referrers are essential to facilitate prompt creation of effective treatment plans.

Humans↗
PubMed2006

Milk-alkali syndrome: a historical review and description of the modern version of the syndrome.

Formerly recognized primarily for its historic interest as a disorder found in those taking milk and bicarbonate for peptide ulcer disease, milk-alkali syndrome (MAS) is experiencing a resurgence in its incidence largely due to the increased usage of calcium carbonate. The modern version of MAS affects a different patient population and has a different etiologic basis than was characterized in the original descriptions of the syndrome. Advances in parathyroid hormone measurement have allowed for improved diagnostic separation between MAS and hyperparathyroidism and have further explained some of the physiologic responses in the resolution of hypercalcemia. We have reviewed the reasons for the increasing incidence of MAS, described the typical patient with the modern form of the syndrome, and further elaborated on the pathophysiology of MAS, as it is currently understood. MAS is an important diagnostic consideration in the patient with hypercalcemia because the syndrome is now common and prompt diagnosis limits permanent kidney function impairment but depends strongly on considering the diagnosis as well as obtaining an over-the-counter medication history.

Calcium Carbonate↗
PubMed2005

Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty.

OBJECTIVE: To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. DESIGN: Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. PATIENTS: Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. RESULTS AND CONCLUSIONS: At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined.

Aged↗
PubMed2005

Intramedullary insertion of the patellar tendon.

This case represents a rare presentation of an intramedullary insertion of the patellar tendon in an otherwise healthy 8-year-old girl. To our knowledge no such phenomenon has previously been reported in the English literature.

Adolescent↗
PubMed2005

Imaging findings of femoroacetabular impingement syndrome.

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement-cam impingement and pincer impingement-are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients' symptoms.

Acetabulum↗
PubMed2005

The transverse humeral ligament: a separate anatomical structure or a continuation of the osseous attachment of the rotator cuff?

BACKGROUND: No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff. HYPOTHESIS: There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 14 shoulder examinations were performed on 7 matched pairs of fresh-frozen cadaveric shoulders. Magnetic resonance imaging scans were performed, followed by gross and microscopic anatomical dissection. RESULTS: In the location of the transverse humeral ligament, magnetic resonance imaging and gross dissection revealed the continuation of superficial fibers of the subscapularis tendon from the tendon body across the intertubercular groove to attach to the greater tuberosity, whereas deeper fibers of the subscapularis tendon inserted on the lesser tuberosity. Longitudinal fibers of the supraspinatus tendon and the coracohumeral ligament were also noted to travel the length of the groove, deep to the other interdigitating fibers but superficial to the biceps tendon. Histologic studies confirmed these gross dissection patterns of fiber attachment and also revealed the absence of elastin fibers, which are more commonly seen in ligamentous structures and are typically absent from tendinous structures. CONCLUSION: There is no identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed mainly by the fibers of the subscapularis tendon, with contributions from the supraspinatus tendon and the coracohumeral ligament. CLINICAL RELEVANCE: According to our findings, dislocations of the long head of the biceps must disrupt at least the deep fibers of the annular sling created mainly by the subscapularis tendon insertion. This finding provides anatomical support for the findings of a positive biceps tendon subluxation or dislocation and subscapularis tear during glenohumeral arthroscopy with a normal-appearing subscapularis during open surgery or subacromial arthroscopy.

Aged↗
PubMed2005

Atlanto-occipital dislocation with traumatic pseudomeningocele formation and post-traumatic syringomyelia.

STUDY DESIGN: A case report of traumatic atlanto-occipital dislocation complicated by the development of anterior and posterolateral pseudomeningoceles and the late development of syringohydromyelia is presented. OBJECTIVE: To describe a unique post-traumatic and postsurgical course following atlanto-occipital dislocation. SUMMARY OF BACKGROUND DATA: Syringomyelia is a significant potential long-term complication in patients recovering from traumatic atlanto-occipital dislocation. Cord enlargement and increased T2 signal can be a marker of abnormal cerebrospinal fluid flow dynamics. This "presyrinx state" can be seen before clinical evidence of neurologic compromise. Pseudomeningocele formation after atlanto-occipital dislocation is rare, with only 3 reported cases. To our knowledge, all reported cases describe retropharyngeal pseudomeningoceles, and posterolateral pseudomeningocele as seen in this case has not previously been described. METHODS: A single case is reported with an emphasis on the imaging findings related to the patient's subsequent neurologic deterioration. RESULTS: Following a pedestrian-motor vehicle collision, the patient received initial evaluation and treatment at a local foreign medical facility, where his cervical spine was cleared. Several days following stabilizing treatment and surgery, the patient was transferred to a foreign-based United States military medical facility and ultimately to our institution, where magnetic resonance imaging demonstrated occipitocervical dissociation. The patient was taken to the operating room for surgical stabilization. Four months after his index operation, the patient underwent halo removal. Follow-up magnetic resonance imaging revealed thickening of the cervical spinal cord in conjunction with diffuse high cord T2 signal and a small low cervical segment of syringomyelia. The patient was observed with follow-up magnetic resonance imaging obtained after 1 month. At this time, the low cervical syrinx had enlarged slightly, a small thoracic syrinx was observed, and cine imaging of cerebrospinal fluid flow demonstrated obstruction at the level of the foramen magnum. The patient was taken to the operating room fordecompression of the foramen magnum and posterior fossa and duraplasty. One month later, the patient's clinical condition began to deteriorate, and repeat imaging showed continued enlargement of the patient's syrinx and hydrocephalus. He was admitted for an urgent shunt procedure but unfortunately sustained cardiorespiratory arrest while on the ward awaiting surgery. CONCLUSIONS: Atlanto-occipital dislocation is rarely survivable, and delayed diagnosis can negatively affect long-term clinical outcome. This case illustrates how, despite early signs of improvement, post-traumatic syringomyelia may occur months or even years after spinal trauma and should always be considered in patients who experience late neurologic deterioration after atlanto-occipital dislocation.

Accidents, Traffic↗
PubMed2005

A case of osteochondritis dissecans in rickets.

Rickets and the decreased ossification associated with it can give rise to abnormally low bone density and weakened osseous structures. Despite this association, rickets has rarely been associated with osteochondral defects, and the imaging findings of this association have not been previously described on magnetic resonance (MR) imaging. This case report presents an adolescent male with a clinical history of rickets and recent-onset knee pain that was determined to be caused by bilateral osteochondritis dissecans. Prompt recognition of osteochondritis dissecans is important, as this entity is a treatable cause of knee pain.

Child↗
PubMed2005

Department of Defense picture archiving and communication system acceptance testing: results and identification of problem components.

The PACS implementation process is complicated requiring a tremendous amount of time, resources, and planning. The Department of Defense (DOD) has significant experience in developing and refining PACS acceptance testing (AT) protocols that assure contract compliance, clinical safety, and functionality. The DOD's AT experience under the initial Medical Diagnostic Imaging Support System contract led to the current Digital Imaging Network-Picture Archiving and Communications Systems (DIN-PACS) contract AT protocol. To identify the most common system and component deficiencies under the current DIN-PACS AT protocol, 14 tri-service sites were evaluated during 1998-2000. Sixteen system deficiency citations with 154 separate types of limitations were noted with problems involving the workstation, interfaces, and the Radiology Information System comprising more than 50% of the citations. Larger PACS deployments were associated with a higher number of deficiencies. The most commonly cited systems deficiencies were among the most expensive components of the PACS.

Civil Defense↗
PubMed2005

Hemophilic pseudotumor.

Bleeding diatheses are a hallmark of hemophilia. Hemophilic pseudotumor results from multiple episodes of hemorrhage into bones or soft tissue spaces. It is uncommon and is seen in severe cases of hemophilia only 1-2% of the time. Complications and symptoms arise due to pain and/or compression of surrounding structures. Pathologic fractures can be associated with intraosseous lesions and can result from bone destruction or resorption due to the chronic pressure of an osseous hemorrhage. Radiographs may demonstrate expansile lesions of the bones or increased soft tissue density that may be associated with extra osseous lesions. Bleeding may also occur within the joint space. These intra-articular hemorrhages can, over time, result in hemophilic arthropathy. The following case report demonstrates both an expansile lesion of a metacarpal as well as hemophilic knee arthropathy in an 11 year old.

Arthralgia↗