Biomedical subjects
Publications and source records attributed to E Avrahami.
Myelofibrosis, known also as myelosclerosis, tends to form myeloid metaplasia in all organs of the body. The nervous system and intracranial structures are rarely involved. A case of myeloid metaplasia in the falx, which caused headache and papilledema, was observed gaining in size on repeated CT scans.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Four patients suffered from trauma of the temporomandibular (TM) joints. They were examined by routine x-ray procedures. The x-ray films failed to demonstrate a chip fracture of the head of the mandibular condyle. A coronal computed tomographic (CT) view established the fracture shortly after the trauma in three patients. These patients improved clinically after physiotherapy. The fourth patient was retrospectively diagnosed as having a chip fracture of the mandibular head. She underwent CT scan 10 months posttrauma , and ankylosis of the TM joint was established. The mechanism and the clinical symptoms of this injury, which have not been previously described, are reported in this article.
Computed tomography (CT) of the temporo-mandibular joint (TMJ) has only been occasionally reported. As CT techniques improve, more detailed information is available. Though conventional radiography of the TMJ can supply sufficient diagnostic detail, it may well be replaced by CT as a preliminary examination, as it is able to offer more information with less radiation and minimal patient discomfort.
Forty patients with known primary tumor and progressive back pain, suspected of having spinal metastatic disease, underwent magnetic resonance (MR) examinations of the thoracic and lumbosacral spine. Conventional radiographs and CT scans of the spine were all normal. The radionuclide bone scans were equivocal. In 21 patients focal or diffuse vertebral MR abnormalities were detected. In nine patients the lesions were hypointense on T1 sequence, and the same lesions were demonstrated poorly or not at all on T2 and proton density sequences. In eight other patients the bone marrow metastases presented with strong signal intensity on T2 and were poorly or not at all demonstrated on T1 and proton density sequences. In three patients with multiple myeloma, the signal intensity pattern of the vertebrae was diffusely heterogeneous, with alternating small foci of strong and weak signals (a mosaic-like pattern). Following the MR studies, needle biopsy confirmed the malignancy in the 21 patients who had shown abnormalities. No correlation between the type of primary tumor and the signal intensity of the vertebral metastases was shown. Possibly the mosaic pattern shown in three of the multiple myeloma patients represents a special case.
CT scans of the maxillary antra in a group of 51 patients with nasopharyngeal carcinoma were compared with those of a control group of 50 patients. Inflammatory thickening of the antral mucosa was demonstrated in 39 of 42 patients with grade WHO (World Health Organization) 2 and 3 nasopharyngeal carcinoma. Biopsy of the antral mucosa in eight of these patients established inflammation and excluded the presence of nasopharyngeal carcinoma in the antrum. In a group of nine patients with WHO 1 tumors, the antral mucosa was normal. Thickening of the antral mucosa was observed in six patients of the control group. The inflammatory thickening of the antral mucosa in the patients with WHO 2 and 3 tumors was obviously more frequent than in the control group. This combination was not found in patients with WHO 1 tumors. The phenomenon cannot be explained by direct extension of nasopharyngeal carcinoma or obstruction of the maxillary osteum. The cause of the mucosal thickening may be immunologic, but remains unclear at this stage. The high frequency of inflammatory thickening of the antral mucosa observed in patients with WHO 2 and 3 tumors should encourage further investigation of causative factors in nasopharyngeal carcinoma.
This study includes 3000 patients undergoing MR imaging, all of them conscious, with no history of alcoholism, drug addiction, heart disease, or schizophrenia. During the course of the MR study, panic attacks occurred in 46 subjects, which prevented continuation of the examination. An IV bolus injection of diazepam was administered, which enabled completion of the examination in all 46 cases. The expected effects of a high blood level of diazepam, such as somnolence, slow reactions, overrelaxation, and inhibition of breathing, were not observed. The panic attacks disappeared rapidly after the injection. The patients agreed to a repeat MR examination under similar conditions, if necessary.
PURPOSE: To determine whether narrowing of the oropharynx increases during relaxation in patients with severe obstructive sleep apnea syndrome. MATERIALS: The study included 23 adult men in whom polysomnography had established a diagnosis of obstructive sleep apnea syndrome. Subjects had an average of 53 episodes of sleep apnea per hour, with each episode lasting 40 seconds or more. Oxygen saturation dropped an average of 22% during sleep. Hypnotic relaxation was induced in all patients, and high-resolution CT scans with sagittal and coronal reconstruction of the oropharynx were obtained in the awake state and during the relaxation state using the same parameters. The cross-sectional area of the oropharynx was measured in a minimum of 10 CT axial sections in each case. RESULTS: In all patients, the narrowest cross-sectional area of the oropharynx was smaller during hypnotic relaxation than in the awake state. The average difference between both measures was 42%. In the awake state, the measurements ranged from 15 to 55 mm2 (average, 38 mm2). During hypnotic relaxation, they ranged from 0 to 35 mm2. Oxygen saturation during hypnotic relaxation dropped in all patients from 9% to 17% (average, 14%). No episodes of sleep apnea were observed during hypnotic relaxation. CONCLUSIONS: In patients with obstructive sleep apnea, airways were demonstrably smaller in diameter during hypnotic relaxation than during the awake state.
OBJECTIVE: This study presents an evaluation of a multidisciplinary approach to patients with chronic back pain. METHODS: Sixty-seven patients with back pain of more than three months duration participated in a comprehensive 4 week program which included back schooling, psychological intervention, and treatment by acupuncture, chiropractic, the Alexander technique and a pain specialist. At admission to the study, patients were asked to complete a questionnaire concerning their socio-demographic background and disease history. Patients also underwent a psychological evaluation based on a questionnaire and an interview. On the basis of this evaluation, patients were graded on three criteria: (i) predominance of psychological factors; (ii) secondary gain; (iii) personality features. At the end of the treatment, patients were divided into three groups according to their degree of improvement. Patients were evaluated at the end of the four week program and after 6 months of follow up. RESULTS: Significant improvement in the pain rating, pain frequency and analgesic drug consumption was observed in the treatment group, and was maintained for a period of 6 months. Satisfactory outcome was correlated to a moderate predominance of psychological factors, good functioning, a high level of motivation, and family support. Poor outcome was associated with a divorced marital status and unemployment, diffuse complaints, post surgery status, a high predominance of psychological factors, and the presence of secondary gain and personality disorders. CONCLUSION: Patients with chronic back pain seem to benefit from this proposed multidisciplinary approach. The improvement was maintained for a period of 6 months. Outcome was clearly related to psychosocial factors.