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Biomedical subjects

E M Levinsohn

Publications and source records attributed to E M Levinsohn.

At least 37 records · Page 2Linked to original sources
PubMed1990

Magnetic resonance imaging of the triangular fibrocartilage complex.

Magnetic resonance imaging of seven fresh human cadaveric specimens was used to evaluate the integrity of the triangular fibrocartilage complex of the wrist. A variety of imaging parameters were systematically investigated, including T1-weighted images with and without contrast, long repetition times, short echo time images, and T2-weighted sequences. A variety of imaging planes were also evaluated. Wrist arthrography, dissection, and frozen coronal sections were done to substantiate our interpretations of the magnetic resonance images. T2-weighted images in the coronal plane proved to be of the greatest diagnostic value because the synovial fluid of the joint spaces serves as an excellent endogenous contrast agent. Long repetition time, short echo time sequences could be simultaneously obtained with T2-weighted sequences with the use of a multi-echo pulse sequence to provide an excellent diagnostic package in the future. On the basis of our investigation, the triangular fibrocartilage complex can be consistently and accurately evaluated with magnetic resonance imaging. As magnetic resonance imaging technology improves, wrist probes and suitable magnets should become available that will make the evaluation of triangular fibrocartilage complex abnormalities with magnetic resonance imaging clinically useful.

Cartilage, Articular↗
PubMed1990

Necrosis leading to amputation following clubfoot surgery.

Amputation after clubfoot surgery is a rare and catastrophic complication. This case report involves an amputation necessitated by postoperative necrosis on the medial side of the foot. To our knowledge, only one brief published report of necrosis following clubfoot surgery exists in the literature, and that report contains little clinical information. Although we know of several additional cases of necrosis following clubfoot surgery, the details of these cases remain unavailable to us for publication. The clubfoot deformity is almost always associated with vascular deficiencies involving the anterior tibial and dorsalis pedis arteries, as well as their derivatives. Since the area of necrosis in this case report coincided with the anatomic distribution of the derivatives of the congenitally reduced or absent dorsalis pedis artery, we suggest that insufficient blood flow to the dorsal and medial sides of the foot, and to the hallux contributed to the necrosis. In our opinion, the surgeon should assume that an abnormal vascular pattern, as described here, is present unless proven otherwise.

Amputation, Surgical↗
PubMed1990

Imaging of the wrist.

A wide variety of radiologic tools now exists for the assessment of the bones and soft tissues of the wrist. The selection of the most appropriate modality requires that the radiologist be conversant both with this armamentarium and with the needs of the referring clinician requesting diagnostic help. Although most static abnormalities may be nicely displayed on routine plain films and special projections, many dynamic abnormalities require motion or stress views to demonstrate their presence. The three-phase radionuclide bone scan allows the radiologist to judge the acute or chronic nature of the abnormality being assessed. Subluxations involving the distal radioulnar joint are relatively easily recognized with CT scanning through that joint. These abnormalities are seen infrequently and are unreliably diagnosed from the plain film examination alone. Although the triple injection arthrogram seems to be a sensitive and accurate tool for identifying ligamentous perforations including those of the triangular fibrocartilage, the potential for those diagnoses to be made with MR imaging is increasingly recognized.

Diagnostic Imaging↗
PubMed1988

The triple-injection wrist arthrogram.

The last 100 patients to have wrist arthrography at our institution had, in addition to the standard radiocarpal joint injection, injections into the distal radioulnar joint and midcarpal joint. Seventy-seven of the 100 patients had abnormal arthrograms. In 29 cases abnormalities not identified by the radiocarpal joint injection were demonstrated either by the distal radioulnar joint or the midcarpal joint injection. In 38 patients abnormalities shown by radiocarpal joint injection were not demonstrable by the other two injections. Seven detachments of the triangular fibrocartilage complex from the ulnar styloid could be demonstrated only by the distal radioulnar joint injection. The midcarpal joint injection was far more useful than the radiocarpal joint injection in the evaluation of radiocarpal joint-midcarpal joint communications. All three injections appear to be necessary for a complete arthrographic evaluation.

Adolescent↗
PubMed1988

Vertebral mineralization after parathyroidectomy: measurement by quantitative CT.

Quantitative CT has been used to document abnormally low levels of vertebral bone mineral in hyperparathyroid states. No one has yet reported an improvement in vertebral bone mineral concentration after parathyroidectomy. Quantitative CT was used to measure mineralization of lumbar vertebral bodies in five women with primary hyperparathyroidism, at the time of surgical resection of a parathyroid adenoma and again 4 months after surgery. Four of the patients had increased vertebral mineralization after 4 months; the increase for the entire group (13%) was statistically significant. In one patient, examined for a third time 8 months after surgery, a continuing increase in vertebral bone mineral concentration was seen. A final examination, obtained 20-33 months after surgery, revealed that in every patient the bone mineral concentration was lower than on the first postoperative study and in some cases was less than the original preoperative measurement. We conclude that a temporary increase in vertebral trabecular mineralization occurs after parathyroidectomy for primary hyperparathyroidism. During the following 3 years, however, this increase is not sustained.

Adult↗
PubMed1988

Freiberg disease complicating unrelated trauma.

Freiberg's infraction is an avascular necrosis of the metatarsal head characterized by the development of disorderliness of chondrogenesis and osteogenesis in previously normal bone. Radiographic findings follow the pathological progression of bony changes. The presented cases document the development of avascular necrosis in a previously normal metatarsal that occurred after trauma or surgery elsewhere in the foot. It is suggested that infraction of the metatarsal head resulted from microfracture caused by abnormal stress.

Child↗
PubMed1987

Soft tissue anomalies in a patient with congenital tibial aplasia and talo-calcaneal synchrondrosis.

We have carried out the third in a series of anatomical dissections of amputated congenitally deformed human limbs in an attempt to determine the etiological relationship between the bony and soft tissue anomalies. This specimen consisted of a limb with congenital tibial aplasia and an adducted foot with five toes. The arterial and nerve patterns were reminiscent of those seen previously by us. The arteries were characterized by absence of the anterior tibial artery and an incomplete plantar arch. The superficial peroneal nerve terminated at the ankle. Extra branches from the sural, deep peroneal, and medial plantar nerves supplied branches to the dorsum of the foot. There were two extra muscles in the leg. The remaining muscles were normal, with the exception that most muscles normally inserting on the plantar surface of the foot inserted instead into a common tendon sheet. The tibia was replaced by a tendinous band, and the talus and calcaneus were united by a complete synchondrosis. The contralateral limb clinically appeared to have a clubfoot. The combination of an absent anterior tibial artery and an incomplete plantar arch is consistent with our theory that a reduced number of vessels puts the embryonic limb at increased risk of congenital defects due to the reduction in the number of collateral blood routes. Some event, such as extravasation of blood or embolization, may concurrently or subsequently compromise blood flow in the remaining vessels. We have previously observed abnormal arterial patterns similar to that described above in limbs having absence of the tibia and in other patients having clubfeet. The presence of abnormal arterial patterns in a limb with absence of the tibia and a contralateral limb with clubfoot suggests that absent tibia and clubfoot may be etiologically related.

Amputation, Surgical↗
PubMed1987

Wrist arthrography: the value of the three compartment injection technique.

Arthrography of the wrist was performed on 50 consecutive patients with obscure post-traumatic wrist pain by injecting contrast separately into the radiocarpal joint, midcarpal compartment, and distal radioulnar joint. When distal radioulnar joint and midcarpal compartment injections were added to the standard radiocarpal injection, many significant unsuspected abnormalities were identified. Of the 25 triangular fibrocartilage complex abnormalities identified, six (24%) were found only with the distal radioulnar joint injection. Of the 29 abnormal communications between the midcarpal compartment and the radiocarpal joint, ten (35%) were found only with the midcarpal injection. Similarly, five of 29 (17%) of the abnormal radiocarpal-midcarpal communications would have been missed if a midcarpal injection alone had been performed. These findings indicate that separate injections into the radiocarpal joint, midcarpal compartment, and distal radioulnar joint are needed to identify a large number of abnormalities not seen with injections into one compartment alone.

Adolescent↗
PubMed1987

Pitfalls to avoid in diagnosing pain in the athlete.

Symptoms in the competitive athlete frequently are assumed to be related to overuse. A limited number of these patients will have orthopedic problems not related to their activity. This article outlines specific examples of bone tumors, infections, and metabolic causes of pain in the athlete.

Adolescent↗
PubMed1987

Enlarged iliopsoas bursa. An unusual cause of thigh mass and hip pain.

Iliopsoas bursa enlargement, a rare cause of pelvic or inguinal mass, can be identified on computed tomography (CT) either incidentally or during clinical examination of a groin mass. When CT examination is equivocal, hip arthrography can establish the diagnosis. Iliopsoas bursa enlargement is frequently associated with preexisting hip arthrosis. In three cases of iliopsoas bursa enlargement, two had preexisting arthritis. A third patient showed no roentgenographic sign of hip disease. Iliopsoas bursa enlargement may be more common than previously reported and should be considered in patients with unexplained hip pain who demonstrate a soft tissue mass in the region of the iliopsoas bursa.

Aged↗
PubMed1985

Left neck mass.

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Head and Neck Neoplasms↗
PubMed1985

Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance.

Eighteen CT examinations were performed in 10 patients for the evaluation of acute intraarticular fractures and their follow-up. Fractures comparable to those in the patients were created in cadavers. The normal anatomy and the traumatically altered anatomy of the calcaneus in the axial, coronal, and sagittal planes are demonstrated by CT and corresponding anatomic sections. Scanning was performed in the axial plane, with subsequent reconstruction in the coronal and sagittal planes. The axial scans show disruption of the inferior part of the posterior facet, calcaneocuboid joint involvement, and widening of the calcaneus. The coronal scans show disruption of the superior part of the posterior facet, sustentaculum tali depression (involvement of middle and anterior facets), peroneal and flexor hallucis longus tendon impingement, and widening and height loss of the calcaneus. The sagittal scans show disruption of the posterior facet, calcaneocuboid joint involvement, and height loss of the calcaneus and allow the evaluation of Boehler's and Gissane's angles. All three planes show the position of major fracture fragments. Radiation dose to the foot was measured to be 0.1 rad (0.001 Gy) for plain film radiography (five exposures), 18 rad (0.18 Gy) for conventional tomography (20 cuts), and 2.6 rad (0.026 Gy) for axial CT examination.

Aged↗
PubMed1985

Radiography and computerized tomography in the diagnosis of incongruity of the distal radio-ulnar joint. A prospective study.

The diagnosis of subluxation or dislocation of the distal radio-ulnar joint may be difficult to confirm by routine radiographs. We undertook a prospective evaluation of fifteen patients with acute or chronic pain in the distal radio-ulnar joint, using both standardized radiographs and computer assisted tomography. In the absence of a deformity of the distal end of the radius, a lateral radiograph made with the wrist in the neutral position accurately revealed incongruency of the distal radio-ulnar joint. When pain or cast immobilization prevented optimum positioning of the wrist for radiography, or when a deformity of the distal end of the radius was present, computer assisted tomography gave a more accurate determination of the congruency of the joint.

Adult↗