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Biomedical subjects

E M Braunstein

Publications and source records attributed to E M Braunstein.

At least 19 recordsLinked to original sources
PubMed1992

Digital skeletal radiography.

Skeletal radiography accounts for a large proportion of the plain film images generated in most radiology departments, yet it has been underemphasized in the investigation of digital imaging technologies. Unique features of skeletal radiography provide a challenge in the evaluation and investigation of digital skeletal imaging. This review summarizes the results of ongoing research in digital skeletal radiography. Elementary concepts of digital imaging are reviewed to provide a foundation for discussion of nominal contrast and resolution requirements for clinically useful digital skeletal radiography. Methods of acquiring digital skeletal images are reviewed, and digital image display, image compression, and basic image processing techniques are discussed with emphasis on specific skeletal applications.

Bone and Bones↗
PubMed1992

A radiographic comparison of erosive osteoarthritis and idiopathic nodal osteoarthritis.

Clinical, radiographic and histologic features suggest that inflammation is central to the pathogenesis of erosive osteoarthritis (OA). Since mediators of inflammation may activate osteoclasts and stimulate release of metalloproteinases in joint cartilage, we hypothesized that patients with erosive OA may have more joint space narrowing and less proliferative bone response (osteophytes, sclerosis) than those with idiopathic nodal OA. Hand radiographs of 33 patients with erosive OA and 33 age and sex matched patients with nodal OA were evaluated for prevalence and severity of joint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts, erosions and subchondral collapse. While the prevalence and severity of OA was greater at each joint in erosive OA than in nodal OA, significant differences (p less than 0.05) were confined largely to the interphalangeal joints. Among patients with erosive OA, radiographic features of OA were more severe in joints with erosive changes than in joints that did not show erosive change (p less than 0.01 in most cases). Notably, when joints with erosive change were excluded, only joint space narrowing was more severe in patients with erosive OA than in the corresponding joints of patients with nodal OA (p less than 0.001). Our analysis did not support the hypothesis that inflammatory mediators modify chondro or osteoneogenesis in erosive OA.

Adult↗
PubMed1991

Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee.

We examined the relationship between articular cartilage degeneration, as visualized arthroscopically, and joint space narrowing (JSN) in standing anteroposterior knee radiographs of 161 patients with chronic knee pain. The majority of these patients had radiographic findings of mild osteoarthritis. Twenty-five (33%) of the 76 patients in the series whose radiographs showed tibiofemoral JSN had grossly normal articular cartilage in both tibiofemoral compartments at arthroscopy (false-positive). The specificity of medial JSN for the presence of medial compartment articular cartilage degeneration was 0.61, i.e., only 61% of patients with normal (grade 0) medial compartment cartilage had a normal medial joint space. Of 22 patients with greater than 50% medial JSN, 9 (41%) had normal articular cartilage in the medial compartment at arthroscopy. Of 6 patients with greater than 50% lateral JSN, 3 (50%) had normal lateral compartment articular cartilage at arthroscopy. Among 36 patients with greater than 25% JSN who had neither medial nor lateral compartment articular cartilage degeneration, JSN was associated with articular cartilage degeneration in the patellofemoral compartment in 8 (22%), with meniscus degeneration in 18 (50%), and with both in 8 (22%). Thus, in these patients with chronic knee pain, radiographic evidence of JSN in the tibiofemoral compartment did not permit confident prediction of the status of the articular cartilage.

Adolescent↗
PubMed1991

Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration.

We examined standing knee radiographs of 92 patients who had chronic knee pain and radiographic evidence of mild or moderate osteoarthritis (OA) according to the Kellgren and Lawrence (K/L) criteria. Because the K/L criteria overemphasize osteophytosis relative to joint space narrowing (JSN), we graded OA severity also with a scoring system that placed greater emphasis on JSN than on osteophytes. In each case, the articular cartilage was visualized directly at arthroscopy. Of 17 patients whose radiographic findings were normal by both the K/L criteria and our JSN-weighted criteria, 7 had advanced tibiofemoral and/or patellofemoral compartment changes of OA seen at arthroscopy, emphasizing the insensitivity of the radiograph for detecting early articular cartilage loss. In addition, tibiofemoral JSN was common in the presence of normal articular cartilage. The JSN-weighted scale provided no advantage over the K/L criteria for assessing the severity of articular cartilage changes of OA.

Adult↗
PubMed1991

Case report 689. Metastatic atrial myxoma to the pubis.

We have presented a 23-year follow-up of a patient with left atrial myxoma with continuing slowly growing, skeletal metastases. The relatively indolent nature of the metastatic disease and the lack of mitotic figures suggest that the metastatic lesions may be treated locally. The patient underwent therapeutic tumor embolization and local resection of the pelvic lesion, with good results as she continues to do well with close follow-up.

Bone Neoplasms↗
PubMed1991

Contrast and nuclear arthrography in loosening of the uncemented hip prosthesis.

The recent popularity of ingrowth or uncemented hip arthroplasties has presented problems in the radiographic diagnosis of loosening because there is no longer a cement interface in which lucencies may be seen. We evaluated a combination of positive contrast and nuclear arthrography to see whether these studies could accurately detect loosening of uncemented femoral components of hip prostheses. We performed routine contrast and nuclear arthrography in 21 patients with ingrowth total hip arthroplasties or bipolar endoprostheses. The results were surgically confirmed in 12 patients. The contrast arthrogram was true positive in 5 and false negative in 5. There were no false positives and 2 true negatives. The nuclear arthrogram was true positive in 7 patients, false negative in 3, and true negative in 2. Taken together, there was only 1 patient in whom both contrast and nuclear arthrography were false negative, and there were no false positives. Thus, when either contrast or nuclear arthrography is positive, the sensitivity of the combined procedures is 90%; when both studies are negative, the specificity is 100%. The combination of contrast and nuclear arthrography is an accurate method of determining loosening of the femoral component of an uncemented hip arthroplasty or bipolar endoprosthesis in the patient with postoperative hip pain.

Adult↗
PubMed1991

Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients.

The sensitivity of magnetic resonance (MR) imaging in the detection of avascular necrosis (AVN) of the hip and natural history of the MR findings were determined prospectively in renal allograft recipients, a group at risk for development of the disease. One hundred four patients were studied up to 24 months after transplantation. In 25 hips in 14 patients, MR findings were consistent with AVN. Pain developed in seven hips in four patients; in each hip, the MR images showed abnormality before the onset of symptoms. Plain radiographs showed abnormality in all hips that became painful; however, the plain radiographs of 17 of 18 asymptomatic hips in which MR imaging showed evidence of AVN showed no abnormality over a mean follow-up period of 16 months. All MR lesions in the symptomatic hips were larger than those in the asymptomatic cohort. MR lesions in seven hips (in five asymptomatic patients) regressed in size; in six hips, the MR images returned to normal. The findings suggest that some patients with MR evidence of AVN of the hip have spontaneous improvement.

Adolescent↗
PubMed1991

Anterior (cranial) cruciate ligament transection in the dog: a bona fide model of osteoarthritis, not merely of cartilage injury and repair.

To help elucidate the longterm outcome in the unstable knees of dogs that have undergone anterior cruciate ligament (ACL) transection, conventional radiography, gait analysis and magnetic resonance imaging (MRI) were performed serially on 3 dogs over a 45-month period after ACL transection. Gait analysis showed that vertical forces generated by the cruciate deficient leg were smaller than those produced by the contralateral leg, but the decrease in loading was not progressive and clinical findings did not suggest that the dogs developed pain in the unstable limb. Despite progressive osteophytosis and subchondral sclerosis, as seen on plain radiographs, MRI demonstrated that articular cartilage in the unstable knee was thicker than that in the contralateral knee 36 months after ACL transection. Nine months later, however, striking focal loss of articular cartilage was seen in the unstable knee of each dog. Our study, which provides the first longterm observations of the changes in the unstable knee after ACL transection, shows that they represent progressive osteoarthritis and emphasizes that a prolonged phase of cartilage hypertrophy may precede the stage of cartilage breakdown.

Animals↗
PubMed1991

The presence of cartilage matrix glycoprotein in serum as determined by immunolocation analysis is not a sensitive indicator of "early" osteoarthritis of the knee.

Widespread effort is being devoted to the search for a serologic "marker" that could aid in the early diagnosis of osteoarthritis and in following the progression of the disease in response to treatment. It is obvious that such a marker would have its greatest utility in patients with mild or early osteoarthritis. CMGP is a disulfide-bonded 550,000 dalton cartilage matrix glycoprotein with a half-life of only 48 to 72 hours that has been found, through immunolocation analysis, in the serum of dogs with experimentally induced osteoarthritis and in the synovial fluid of patients with osteoarthritis but not other types of arthritis. To determine whether detection of CMGP in serum might be of value in identifying patients with "early" osteoarthritis, we examined serum samples from 26 patients with knee pain who had articular cartilage lesions of osteoarthritis at arthroscopy but whose knee radiographs were normal or showed only mild or moderate osteoarthritis. CMGP was identified by immunolocation analysis with specific antibodies. Eleven patients (42%) were seropositive for CMGP. In two, the degenerative cartilage lesions visualized at arthroscopy were mild (grade 2); in the other nine they were more severe (grade 3 or 4). However, 10 of the 15 seronegative patients also had grade 3 or 4 cartilage degeneration. Thus, this serum assay for CMGP was often negative in this group of patients in the presence of well-defined cartilage degeneration.

Adult↗
PubMed1991

Evaluation of joint disease in the adult hand and wrist.

The radiographic evaluation of joint diseases in the adult hand and wrist is described in this chapter. The main focus is on the interpretation of plain radiographs of the hands and wrists in patients with joint symptoms. After considering the general approach to the analysis of the radiographs, the findings of the common forms of arthritis are illustrated and the differential diagnoses are discussed.

Adult↗
PubMed1990

Three-dimensional computed tomography of the mummy Wenuhotep.

Computed tomography allows cross-sectional imaging of anthropological as well as clinical subjects. Recently, technical innovations have made three-dimensional reconstruction of these images feasible. We performed two-dimensional and three-dimensional computed tomography of a Late Period Egyptian mummy to reexamine findings seen on previous radiographic studies and to evaluate the usefulness of these techniques in paleopathology. Two-dimensional images provided excellent anatomic detail. There was graphic depiction of the mummification process that corroborated information previously obtained from Egyptological studies. Three-dimensional reconstruction provided images of facial features as if the mummy had been unwrapped. Three-dimensional computed tomography is a useful method of nondestructively evaluating paleopathological remains, and it may yield information not obtainable by any other means.

Female↗
PubMed1990

Rapidly progressive Charcot arthropathy following minor joint trauma in patients with diabetic neuropathy.

Neuropathic (Charcot) arthropathy is a slowly progressive, chronic, destructive form of joint degeneration seen in patients with a neurosensory deficit. Attempts to produce neuropathic joint disease experimentally with a variety of deafferentation procedures have generally been unsuccessful. However, if the knee is rendered unstable by anterior cruciate ligament transection (ACLT), breakdown of the joint occurs rapidly in dogs that have previously undergone dorsal root ganglionectomy (DRG) for deafferentation of the ipsilateral limb. In contrast, ACLT in neurologically intact dogs produces not only nonprogressive changes that are characteristic of mild osteoarthritis. This report describes 3 patients with longstanding insulin-dependent diabetes mellitus in whom neuropathic arthropathy developed within weeks after minor trauma to the foot or ankle. In these patients, diabetic neuropathy served as the functional equivalent of dorsal root ganglionectomy, and the minor trauma served as the functional equivalent of ACLT. Together, they illustrate the phenomenon of neurogenic acceleration of joint degeneration in humans.

Adult↗
PubMed1990

MRI demonstration of hypertrophic articular cartilage repair in osteoarthritis.

Transection of the anterior cruciate ligament in the dog produces changes in the unstable joint typical of osteoarthritis, although full-thickness cartilage ulceration is rare. Information concerning the late fate of the cartilage after transection is meager. In the present study magnetic resonance imaging (MRI) was used to evaluate cartilage abnormalities 3 years after transection. Plain radiographs of the osteoarthritic and contralateral knees were obtained serially. MRI was performed 3 years after anterior cruciate ligament transection, at which time all three animals exhibited knee instability. Radiographs of the osteoarthritic knees showed osteophytes and subchondral sclerosis with progression between 2 and 3 years. On MRI, articular cartilage margins in the knee were indistinct, and the cartilage was thicker than that in the contralateral knee (maximum difference = 2.7 mm). This increase in thickness is consistent with biochemical data from dogs killed up to 64 weeks after creation of knee instability, which showed marked increased in cartilage bulk and in proteoglycan synthesis and concentration. The findings emphasize that increased matrix synthesis after anterior cruciate ligament transection leads to functional cartilage repair sustained even in the presence of persistent alteration of joint mechanics.

Animals↗
PubMed1990

Growth plate injury of the hand and wrist in renal osteodystrophy.

We present two cases of growth plate injury of the hand and wrist in young patients with renal rickets and osteodystrophy but no history of antecedent trauma. The postulated mechanism of injury is subclinical biomechanical stress on the involved extremity superimposed on the already weakened metaphysis and growth plate. Thus, the findings may be viewed as an insufficiency injury to the metaphysis and growth plate. Physicians should be aware that, in the absence of unusual athletic activity, epiphysiolysis of the upper extremity is uncommon and requires a search for underlying metabolic bone disease.

Adolescent↗
PubMed1990

Synovial inflammation in patients with early osteoarthritis of the knee.

While synovitis is common in advanced osteoarthritis (OA), its prevalence and severity in patients with early or mild OA are uncertain. In our study synovial biopsies from patients with arthroscopic evidence of OA whose radiographs were normal, or showed only mild/moderate changes of OA, were examined to determine the prevalence and severity of lining cell proliferation and mononuclear cell infiltration. Synovitis was present in only 16 of 29 patients (55%) who underwent arthroscopy because of chronic knee pain and were found to have OA; no synovium from 50% of the 22 patients in this group with full thickness cartilage ulceration showed infiltration with mononuclear cells. Similarly, no evidence of synovitis was seen in biopsies from 7 of 14 additional patients with OA who did not have knee pain but who underwent arthroscopy to evaluate joint instability. An association was seen between synovial mononuclear cell infiltration and thickness of the synovial lining cell layer (p less than 0.03), but lining cell hyperplasia was found in samples from only 12% of the patients with OA in our series. The severity of OA cartilage lesions was unrelated to severity of synovitis and no topographic relationship was found between cartilage ulceration and synovitis.

Adult↗
PubMed1990

Diagnostic imaging of osteomyelitis.

There are many imaging procedures for diagnosing osteomyelitis, each with unique strengths and weaknesses. Plain radiographs are inexpensive and can be very accurate but may provide a delayed diagnosis. Computed tomography and magnetic resonance imaging are both excellent at differentiating soft tissue infection from osteomyelitis. Computed tomography, magnetic resonance imaging, and bone scans are accurate diagnostic tools for use when the bone has not be violated by surgery, trauma, or other structural alterations. When such changes are present, an Indium-111 leukocyte or Indium-111 polyclonal antibody study may be necessary for accurate diagnosis.

Bone and Bones↗