Biomedical subjects
G Morvan
Publications and source records attributed to G Morvan.
[Significative reduction of secondary effects of radicular myelography using an ultra-fine puncture needle].
The authors report the adverse reactions to myelography in two groups of patients. The only difference was the spinal needle size: 20 G (0.9 mm) in the first group versus 26 G (0.45 mm) in the second one. In the second group the adverse reactions appear 3 to 10 less frequent and 3 to 5 less lasting.
[Lesions of the acetabular rim. Clinical manifestations, therapeutic strategies and perspectives].
Partial rupture of the acetabular rim have usually been described as accompanying traumatic or dysplasic dislocations of the hip. The five cases reported here are in favor of a specific pathology of this fibrocartilage as it is in the knee or the shoulder. Besides, the functional symptoms are not without reminding that of these two joints with sudden onset of cracks, jerks, blockings and even a real joint instability. The pain is never isolated, but may accompany other disorders. The cases were selected in order to evaluate the clinical manifestations and the therapeutic consequences of such a lesion according to the articular history. The diagnosis can only be confirmed with arthrography, which, in addition, permits to evaluate the size of the rim and the condition of the cartilage. The three patients who underwent surgery presented the lesions shown on arthrography. The problem lies in the possible arthrogenic potential of a tear, left in place because minimally disabling for the patient.
[Echography of the musculoskeletal system].
The recent, highly efficient and simple systems have enabled ultrasound to find a specific place in the imaging of the musculoskeletal system within a few years. The daily "on-site" examination currently completes plain radiographs with a particularly effective, non-traumatic and cheap exploration of a number of pathological cases, including traumatic musculotendinous lesions and periarticular soft tissue. After describing the normal images and the semiology of the major diseases for which this technique can be used, the author reviews the appearance of the main regional osteoarticular lesions (shoulder, hip, knee, extremities, etc.), with ultrasound.
[Computed tomographic measurement of the angle of torsion of the femoral neck. Experimental reliability study on dry bone].
To assess the accuracy of CT scanning measurements of femoral anteversion, 35 adult dried femora were studied by CT scan and direct measurement. The angle of the femoral neck was measured directly and the angle of anteversion by photography and by CT scanning. The accuracy of the CT scanning measurement was between 3 degrees and 4 degrees, which is consistent with other published findings. There was no significant difference between photographic and CT scanning measurements. The accuracy and reliability of the method does not alter if there is coxa valga or an increased angle of anteversion. The determination of the axis of the femoral neck remains the most difficult feature, as in other techniques of assessment.
[Magnetic resonance imaging in the diagnosis of soft cervical disk hernia. Evaluation report on 20 cases previously examined by x-ray computed tomography].
Twenty successive patients were examined using CT scanning followed by M.R.I. Thirteen were subsequently operated upon. The results are reported in detail, specifying which signals were used to make the diagnosis of cervical disc prolapse. Short sequences were used for degeneration in the herniated disc, disc protrusion into the spinal canal and compression of the spinal cord. Long sequences were used for indentations or blocks in the cerebro-spinal fluid column at the level of the disc prolapse. Ordinary disc degenerations and associated stenoses are also shown. The reliability of the method was established by comparison with radiographs and surgical findings which were shown to be positive in all the 13 cases treated surgically. The report discusses the difficulties and current limitations of magnetic resonance imaging such as the scarcity of machines, the supine position, the length of the examination, the mediocre quality of horizontal axial sections and difficulties in transmitting magnetic resonance information. There is expected to be rapid and decisive progress with the use of rapid imaging, the preferential choice of sequences, the use of scout views and closer collaboration between radiologist and clinician. A final section is devoted to a discussion of the relative merits of CT scanning and M.R.I. The latter has the advantage of providing total three-dimensional information, particularly in the sagittal plane with a better appreciation of the relationship between container and contents and a method which is strictly non-invasive with the use neither of contrast medium nor X-rays. The authors conclude that M.R.I. provides a positive contribution to the diagnosis of cervical disc protrusions and that this technique can, from now onwards, be considered the examination of choice.
[Small ways of improving the visualization of the last cervical vertebrae on a scanner].
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[Unusual indications for scanning in osteoarticular pathology].
The authors take stock of current applications of the scanner in osteoarticular pathology. At first (1978-1983 approximately), only the vertebral column could be studied by this technique. Now, almost all the osteoarticular system is susceptible to study. Established examples are: study of the sacrum, of the traumatized acetabulum, of the femoropatellar apparatus, and measurement of torsion in the lower limbs. New applications are: study of the back of the foot, of the patellar cartilage, of the glenoid cavity, of the bones and soft parts of the hand, three-dimensional reconstructions, scanning radiology. The authors index and analyse these new techniques.
[X-ray computed tomographic exploration of cervico-brachial neuralgia. Value of the intravenous injection of contrast media].
Cervicobrachial neuralgias can now be easily evaluated by computerized tomography of the cervical spine due to recent technical progress (improved resolution, ultra-thin cuts, precise localization by computed radiography), and especially the use of intravenous contrast material, thus avoiding intrathecal metrizamide. The authors describe normal findings obtained by this method as well as disk herniations and disco-uncarthrosis. On the basis of this initial study of 35 patients (7 disk herniations and 16 disco-uncarthrosis), this method could be employed following routine studies as the first preoperative examination for cervicobrachial neuralgia. Thus, the indications for cervical myelography would decrease, limiting the use of a more invasive procedure and patient discomfort.
Anatomy and radiological anatomy of the lumbar radicular canals.
The radicular canal is the lateral portion of the spinal canal when it is trefoil. It is a bony and ligamentary, monovertebral and indeformable space, the measurements of which are reproducible. The anatomy of this radicular canal has been studied in the whole of the lumbar vertebrae of 50 anatomical subjects. Its radiological anatomy has been defined by sagittal and computerised tomographies of these anatomical specimens, while sagittal tomographies were done for 25 control individuals devoid of symptoms. This canal, exceptional in the upper part of the lumbar canal, has been found in 72% of the cases in L4 and always in L5 and S1. Its sagittal diameter, which when measured must take into account the upper margin of the pedicle, has a theoretical minimal diameter of 3 mm to 3.8 mm, according to the vertebral level. 13% of the vertebrae were asymmetrical and no significant relationship exists between the median sagittal diameter of the spinal canal and the diameters of the radicular canals. Conventional sagittal tomography provides two types of images, according to the shape of the mouth of this canal and furnishes the best measurements (92% of the measurements were concordant), as long as the technique is followed closely. Transverse computerised tomography is less reliable, for the positioning of the section plane still remains the principal cause for error in measuring, but it provides a definition of the relations of the nerve elements with this canal. This radiological study will be suitable for sagittal reconstruction by computerised tomography, once this kind of examination can produce pictures of bones as detailed as those of conventional tomography.
[Tuberculosis of the cervical spine. Radiological study apropos of a multicenter series of 53 cases].
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[Cervical spondylolysis. 7 cases. Review of the literature].
Seven cases of cervical spondylolysis are reported one of them with cervical myelopathy, and the literature is reviewed. The particular anatomical features of the articular processes observed in 4 cases, as well as the many characteristics common to cervical and lumbar spondylolysis, suggest that both diseases might be caused by acquired fatigue fractures of the isthmus due to abnormal stress in patients predisposed by neural rich malformations.
[Computed x-ray tomographic evaluation of cervico-brachial neuralgia with intravenous injection of contrast media].
Investigation of the cervical epidural space by a CT scan is facilitated by its filling following intravenous injection of a contrast medium. The spinal ganglia and nerve root sheaths are visualized as negative images in the intervertebral foramen. A herniated disc is seen as a focal protrusion of the anterior epidural space presenting a clearer center (60 to 80 HU) than at the periphery (100 to 120 HU). Disco- osteophytic protrusion is seen as an arthritic hypertrophy of the uncus and a more widespread overlapping of the disc, often with a posterior body osteophytosis. The spinal cord and subarachnoid space are also visualized more clearly than when injections are not given. This technique is proposed as the initial examination after standard films, for preoperative investigation of a resistant cervicobrachial neuralgia .
[Bone metastasis of a benign uterine leiomyoma. First case in the literature].
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Leiomyomatosis metastasizing to the spine. A case report.
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[Stenosis of the lumbar canal: nosologic and semeiologic study. 163 operated cases].
The authors report a retrospective study of 163 cases of degenerative or constitutional stenosis of the lumbar canal. In this series, the most frequent cause was osteoarthrosis and constitutional stenoses were relatively rare. The authors note that this is often a difficult aetiological distinction to make, especially in elderly patients and the anatomical deformities caused by osteoarthrosis lead to stenosis of the canal similar to that seen in constitutional malformations. Sensori-motor claudication is inconstant and was only found in one third of the cases in this series. More often, the lumbar stenosis presents as nerve root pain. It can be distinguished from root disease of disc origin by the frequent absence of Lasegue's sign and of spinal stiffness. When a herniated disc is associated with a stenosis, the clinical picture is altered and can then resemble that of disc sciatica. The diagnosis of stenosis depends on the radiological examination. This series confirms the diagnostic value of the abnormalities seen on standard X-rays, but the severity and the extent of the stenosis can only be assessed by performing tomography, water-soluble contrast myelography and C.T. scan. The authors discuss the limitations and degree of reliability of each of these investigations. The extent of the surgical decompression depends on the severity of the symptoms and on the results of this radiological survey.
[Value of the use of a guiding forceps for punctures under radioscopic control].
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[Tomodensitometric measurements of the bony lumbar spinal canal. I. Radio-anatomic correlation].
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