Biomedical subjects
Publications and source records attributed to G M Weisz.
The value of M.R.I. in diagnosing spinal disorders has been tested in a series of 100 patients. C.T., myelography, discography and the operative findings are compared with the M.R.I. findings. The results indicate that M.R.I. is a valuable diagnostic investigation.
A retrospective study on the value of magnetic resonance imaging (MRI) in replacing contrast studies of the lumbar spine has been undertaken. Studying pre- and postoperative conditions, the authors attempted to answer the question, Will MRI replace myelography? In this retrospective study, comparison is made in 20 patients between MRI and myelography and with 12 intra-operative findings. The overall impression was that MRI is equally sensitive as the invasive myelogram in diagnosing both protruded lumbar discs and postoperative fibrosis. The practical conclusion was an almost complete abandonment of myelography.
An aggressive and recurrent pigmented villonodular synovitis of the knee occurred in a 47-year-old man. Magnetic resonance imaging was an excellent noninvasive diagnostic aid that completely outlined the extent of the synovitis and correlated well with surgical findings.
Magnetic resonance imaging is a new diagnostic procedure which may be applied to diseases of the lumbar spine and its contents. The technique is non-invasive and does not use ionizing radiation; it also has better contrast resolution than do other methods that are available. This article explores the application of the technique to postoperative conditions of the lumbar spine in relation to problems such as discitis, residual disc material, fibrosis, the size of the surrounding fatty tissue, and the shape of the neural contents.
A group of 29 patients with symptomatic Paget's disease of bone was studied. Certain clinical aspects have been found to be changing, relating to ethnic and family incidence, lumbar stenosis, and neoplastic association.
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In 11 patients with Forestier disease 4 were shown to have obliteration of the sacroiliac joints. We suggest that if patients with this disease are observed for a long period ossification of the sacro-iliac joints will be seen, as in ankylosing spondylitis, with loss of sacro-iliac pain when present.
A normal width of the peridural intracanal spinal space has been described as necessary for normal neural tissue mobility. This virtual functional space, called spinal reserve capacity (SRC) is measurable with the aid of computerized tomography. Aging and various lumbar pathological conditions have been described as leading to attenuation or obliteration of this reserve capacity, a phenomenon essential for a symptomatic lumbar canal stenosis. This article discusses delayed, post-traumatic obliteration of the SRC, and its symptoms and signs are illustrated with ten case histories.
A series of 15 postlumbar laminectomy patients was investigated for residual disease. Clinical, myelograpic, and CT correlation was studied. With the assistance of contrast material injections, a "fibrographic effect" was obtained in scar tissue, differentiating it from residual disc material. The viability of free fat graft is detectable with CT technique.
In spinal surgery, free fat grafts can be placed to limit the ingrowth postlaminectomy fibrous tissue. A specimen of free fat graft recovered from the spinal canal of a patient after 40 months showed histological evidence of revascularization. The reparative, dense fibrosis surrounding the laminectomy site had not penetrated into the spinal canal.
The lumbar syndrome of Paget's disease is classified according to its severity, clinical findings, biochemical factors, and radiological pattern. Pagetoid spinal stenoses may occur in three stages as a progressive clinical syndrome. Several diagnostic procedures, including computerized tomography, (CT) are analyzed to introduce the concept of Spinal Reserve Capacity (SRC). Treatment with calcitonin is recommended at the appropriate stages of the syndrome.
Hyperostosis of the spine, Forestier's disease, is a rare, but well defined entity which results from silent, extensive paraspinal calcification. It has been regarded as an asymptomatic ankylosis requiring no medical or surgical treatment. Two patients with Forestier's disease are presented who show severe stenosis of the lumbar canal with early symptoms of neurological compression.
Three patients with Paget's disease of the spine presented a non-characteristic lumbar syndrome with minor neuromuscular dysfunction. It is proposed that this be called a premyeloneuropathic syndrome since it is an early stage of an imminent severe myelopathic syndrome. The suspected lumbar canal stenosis in Paget's disease is diagnosed by computerised tomography and successfully reversed by calcitonin.
A case of aplastic arch of the atlas (Keller's type) with severe injury to the cervical spine is presented. The impact of the accident was intense enough to produce bony compression of the C7 vertebra, but no injury occurred to the neural elements in the upper cervical spine. The presence of the ligamentous apparatus maintaining the stable movements of the first vertebral connections is of interest. No delay in recovery occurred, and no late complications developed in the seven months following the accident.
Radiologic measurement of central spinal canal diameters is considered a static measurement and does not necessarily indicate active stenosis. A free intracanal space is detectable with CT scanning, i.e., a container/content difference expressing reserve capacity and implying a functional identity. The obliteration of this space may induce clinical symptomatology in the elderly and in persons with developmental or acquired lumbar spinal conditions. Normal and pathologic measurements are presented.
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The present paper described the technique of intravenous hyperalimentation applied to a group of 100 surgical patients. A specially prepared diet supplying a high amount of calories, using hypertonic glucose and supplying nitrogen, using polypeptides or aminoacid solutions, was infused into the superior vena cava. The inhibition of digestive secretions, during the period of hyperalimentation, was used in the management of 19 patients with intestinal and pancreatic fistulae. The general conclusion reached after wide clinical experience was that by supplying energy and nitrogen to a patient in a severe catabolic state, a significant and sometimes dramatic capacity could be developed which allowed him to overcome difficult conditions and even initiated a reversal of the metabolic balance in the direction of anabolism. The regimen should be adopted in the preoperative preparation of debilitated patients; in hypercatabolic states (post-trauma, post-surgery or burns); in gastrointestinal, granulomatous or infectious diseases; in acute pancreatitis; in digestive fistulae; in oncological conditions, and so on. The metabolic and infective complications can be pregressively decreased and eventually prevented by proper handling and strict metabolic monitoring. The use of this hyperalimentation was extremely encouraging, and on many occasions we had the impression that it was life saving.