[Numerical revolution in radiology].
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Humans↗
Biomedical subjects
H M Hoogewoud
Publications and source records attributed to H M Hoogewoud.
Treatment of proximal humerus fracture using multiple intramedullary flexible nails.
A total of 61 patients with a proximal humeral fracture was treated between January 1996 and March 1998 by closed reduction and fracture fixation with intramedullary Prévot (or Nancy) nails. Of these, 28 female and 25 male patients with a mean age of 52 years (range 3-91 years) were reviewed clinically and radiologically with a mean follow-up of 17 months (range 4-30 months). The mean Constant score was 63, the mean Neer score 74 and the mean visual analogue scale (VAS) 73. The 14 patients under 24 years old achieved a Constant score of 86, a Neer score of 99 and a VAS of 97, while 13 patients aged between 25 and 60 years had a Constant score of 67, a Neer score of 75 and a VAS of 71. The 26 patients older than 61 years had a Constant score of 48, a Neer score of 61 and a VAS of 61. One patient with total and 6 with partial humeral head necrosis as well as 5 pseudarthroses were noted. Proximal nail perforation of the humeral head due to fracture collapse was seen in 22 cases. Complications were more frequently observed in the elderly. End results were not related to the type of fracture. This minimally invasive technique decreases the rate of occurrence of avascular necrosis of the humeral head. However, fractures are not sufficiently stabilised, mainly because of bone loss induced by impaction and osteoporosis. Bone loss remains an unsolved problem, and alternative methods such as the use of bone substitute combined with minimally invasive techniques should be studied.
Activities of Daily Living↗
Recovery of severe sciatica.
STUDY DESIGN: A prospective study of patients with acute severe sciatica. OBJECTIVES: To 1) describe the characteristics of patients with acute severe sciatica and the agreement among different diagnostic tests, 2) describe overall recovery during 1 year in terms of perceived disability, and pain, and 3) explore acute-phase predictors of failure to recover at 1 year. SUMMARY OF BACKGROUND DATA: The development of imaging techniques has been very impressive during recent decades. However, different authors have highlighted the prevalence of abnormal images among asymptomatic subjects. These findings increase the difficulty of interpreting the results from the diagnostic techniques used with each individual patient. Furthermore, other clinical and biopsychosocial variables need to be explored for their associations with recovery or failure to recover. This study aimed to explore those associations. METHODS: Consecutive patients admitted to the hospital for conservative management of severe acute sciatica were eligible for inclusion in the study. Patients were evaluated at admission, discharge, and 3, 6, and 12 months. All the visits included a standardized clinical examination and the completion of questionnaires that included items on demographics, pain, perceived disability, and quality of life. Imaging and blood samples were collected at the first visit, and an electromyogram was taken for sciatica lasting at least 3 weeks. RESULTS: The study included 82 consecutive patients (66% men) with a mean age of 43 +/- 10.3 years. The mean intensity of pain, on a visual analog scale of 0 to 100 (VAS) at Visit 1, was 73. The straight leg raising test was positive in 78% of the patients, with a mean value of 59 degrees +/- 18 degrees. The contralateral straight leg raising test was positive in 20% of the patients. Imaging was positive for disc herniation in 74% and electromyogram was positive in 62% of cases. These two diagnostic tests showed a good to excellent total agreement (58-87%) with the straight leg raising tests and the presence of radiating pain below the knee. The recovery of clinical symptoms and signs was observed mainly within the first 3 months. However, clinical recovery and perceived recovery was not complete in most cases. CONCLUSIONS: In most cases, there was good to excellent agreement among the different diagnostic tests. None of the tests was predictive of recovery. The presence of blood antibodies against 3'LM1 (IgM + IgG) and GD1a (IgM) was significantly associated (P < 0.023) with neurologic symptoms and signs. However, the meaning of these antibodies remains unclear. Only a minority of the patients (29%) had fully recovered after 12 months. Within the 1-year follow-up, one third of the patients had surgery.
Adult↗
A new catheter type for superselective angiography and embolization.
UNLABELLED: PURPOSE AND MATERIAL: A new family of catheters was developed to overcome the shortcomings of conventional catheters and to avoid the use of coaxial catheters in superselective angiography and embolization. The new catheter is nylon, 1.67 mm (JF) long, and has a rigid proximal part (to ensure torque control and pushability) and a long 2-step flexible tip (to follow arterial tortuosities). It has a hydrophilic coating, and a long-lasting shape memory. This new catheter type was compared experimentally with conventional catheters. RESULTS: Clear advantages were found with the new catheters in pushability and trackability as they, more often than conventional catheters, permitted us to reach the periphery of an artery. Departmental experience with the new catheters currently amounts to over 500 arterial procedures. CONCLUSION: The new catheters could frequently replace coaxial catheters, which would contribute towards reducing the costs of intravascular procedures.
Angiography↗
[Transvascular percutaneous intervention in tumors: principles and indications].
The techniques of interventional radiology in cancer therapy have been known for several years. Like other radiologic specialties it has benefited from rapid developments in imaging and catheter technology. The indications for percutaneous vascular therapy of tumors are generally palliative and have a curative intention only in rare conditions. Interventional techniques are useful in therapy of tumor bleeding and preoperatively to lessen the risk of hemorrhage. They effectively reduce tumor bulk and provide symptomatic relief. The techniques, indications, results and complications of transvascular therapy of tumors are described.
Antineoplastic Combined Chemotherapy Protocols↗
Absence of avascular necrosis of the humeral head after post-traumatic rupture of the anterior and posterior humeral circumflex arteries. A case report.
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Angiography↗
Iobitridol 300 compared to iopromide 300--a double-blind randomized phase-III study of clinical tolerance in total body CT.
UNLABELLED: PURPOSE, MATERIAL AND METHODS: The clinical safety of iobitriodol 300 mg I/ml and iopromide 300 mg I/ml were compared in a randomized double blind phase-III study conducted on 60 patients undergoing abdominal CT for a variety of indications. Each examination was rated as diagnostic or nondiagnostic and the image quality was noted. Nature, onset, intensity as well as outcome of each adverse reaction were recorded. RESULTS: There was no significant difference in imaging quality and side effects between the contrast media. In this study, both iobitridol and iopromide provided excellent image quality and a low rate of side effects. CONCLUSION: Iobitridol is a safe and effective nonionic contrast agent for contrast-enhanced body CT.
Adult↗
Gamekeeper thumb: identification of the Stener lesion with US.
PURPOSE: To determine the value of ultrasound (US) in recognizing the ligamentary dislocation occasionally associated with gamekeeper thumb (Stener lesion). Detecting such dislocations is important because they require surgical repair, whereas nondisplaced ruptured ligaments respond to conservative treatment. This dislocation cannot be reliably diagnosed with standard methods, leading to unnecessary surgical procedures. MATERIALS AND METHODS: Forty-eight hyperabduction injuries of the thumb were included. The thumbs were either unstable or unexaminable because of tenderness. No fractures were seen on standard radiographs. RESULTS: Sonograms were positive in 13 patients, who then underwent surgery. A Stener lesion was found in 10 patients and a partial Stener lesion in three. Three patients with negative sonograms also underwent surgery, and no dislocation was found. The other 32 patients with negative US findings were treated conservatively, and none developed subsequent instability. CONCLUSION: US proved to be a reliable, simple, and easily reproducible tool for recognition of the Stener lesion.
Adolescent↗
[Echography of the hip in infants. Why absolute deference to Graf's criteria is necessary].
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Female↗
Radiological analysis of normal axial alignment of femur and tibia in view of total knee arthroplasty.
Alignment of the anatomical and mechanical axes of the lower extremities was analyzed using standardized radiographs in two series of 66 femur and 44 tibia specimens. A new anatomical axis, the distal femoral anatomical axis, was introduced. This axis corresponds to the overall femoral anatomical axis and encloses a valgus angle of 6 degrees with the mechanical axis of the femur. It allows for design of shorter intramedullary guiding instruments that will still be in congruency with true femur geometry. Comparison with computerized calculations of angles on computed tomography scans on a series of 38 bones shows a high precision of measurement on standard radiographs in neutral rotation.
Adult↗
Uncommon origin for the iliopsoas sign.
The term "iliopsoas sign" has different meanings in the medical literature. Among musculoskeletal disorders, iliopsoas bursitis is probably the most common cause of this clinical sign. Here we report an unexpected vascular pathology in a young man. The only clinical manifestation on examination was an iliopsoas sign.
Adult↗
[Double-blind randomized study comparing ioversol 300 versus iopromide 300 abdominal computed tomography (CT scanner)].
The authors compared ioversol 300 and iopromide 300 (ioversol 41 patients, iopromide 38 patients) in a randomized double blind study conducted on 79 patients undergoing abdominal computed tomography (CT) for a variety of indications. Each study was rated as diagnostic or non-diagnostic and the image quality was recorded. All side-effects were recorded. There was no significant difference in image quality and side-effects between both contrasts. In this study, both ioversol and iopromide provided excellent image quality and a low rate of side-effects. The authors conclude that ioversol is a safe and effective non ionic contrast agent for contrast enhanced body CT.
Adult↗
Infective iliopsoas bursitis. A case report.
We report a case of infective iliopsoas bursitis, and to our knowledge a similar case has not been described. The anatomical relation between the bursa and the hip, and related pathological conditions are reviewed. The contribution of CT-guided catheterisation is emphasised as it allows aspiration of fluid, injection of radio-opaque material and lavage.
Adult↗
Cerebral venography with MR.
The authors describe a two-dimensional time-of-flight magnetic resonance (MR) angiography technique to create projection venograms of the head. The technique was applied to 27 healthy volunteers and 39 patients. The superior sagittal and straight sinuses, the internal cerebral veins, and the Galen vein were visualized in all the volunteers. Other veins were seen in a high percentage of subjects. Systematic comparison of digital subtraction angiography (DSA) after intraarterial contrast medium injection and MR venography in patients showed good correlation between the two techniques. MR venography proved helpful in identifying thrombosis or patency of cerebral veins and sinuses and showed collateral venous drainage and venous drainage from arteriovenous malformations. There was good correlation between conventional contrast angiography and MR venography. In conclusion, MR venography is considered reliable for showing the cerebral venous system and provides information additional to that of conventional spin-echo imaging.
Adolescent↗
[Prevention of pulmonary embolism with the Günther filter].
From 1987 to 1989 a Günther vena caval filter was implanted in the inferior caval vein in 37 patients to prevent pulmonary embolism. 20 patients had already suffered from lung emboli and full anticoagulation did not prevent reembolization (11) or was contra-indicated because of hemorrhagic complications (5) or recent operation (4). 17 patients had developed severe deep venous thrombosis with a free ending thrombus (15) as shown by phlebography and in 2 other patients of old age prophylaxis seemed indicated to prevent migration of the thrombi. This device can be inserted percutaneously via a 10-French introduction system. No local complications were observed. 3 patients showed an oedema of a leg 2 to 7 days after insertion with spontaneous regression. One patient had the filter 12 days after implantation completely obstructed by a new embolus that needed to be removed surgically. One patient had an acute caval obstruction 1 1/2 years after implantation. it could not be determined if this was due to new embolisation or to thrombosis of the filter. No pulmonary reembolization was observed. Even if long-term results with the Günther vena caval filter can not be reported yet, it seems to be a satisfactory device for preventing pulmonary embolism.
Adult↗
[Magnetic resonance angiography. Work in progress].
Rapid progress has been made in the development and clinical application of magnetic resonance (MR) techniques for creating angiogram-like images of blood vessels. Combinations of techniques such as gradient-echo pulse sequences and flow compensation (bright blood imaging) or presaturation (black blood imaging) permit the signal intensities of moving spins to be altered, so as to generate contrast between flowing blood and stationary tissues. Postprocessing of the images allows the creation of projection angiograms, which show the vasculature in a large slice of the body. Preliminary studies suggest a variety of potential clinical applications, including intracranial arteriovenous malformations and aneurysms, carotid artery disease, portal hypertension, renal artery stenosis, peripheral arterial disease and venous thrombosis. At present, MR angiography is not directly competitive with conventional contrast angiography because of lower spatial resolution and loss of signal from flow turbulence and from slow flow. Nonetheless, it is proving to be a useful clinical tool for the investigation of vascular pathology involving the head and body.
Angiography↗
Cerebral blood flow: assessment with dynamic contrast-enhanced T2*-weighted MR imaging at 1.5 T.
The authors assessed regional cerebral blood flow dynamics with magnetic resonance (MR) imaging enhanced with gadolinium diethylenetriaminepentaacetic acid (DTPA). After bolus administration of Gd-DTPA, rapid T2*-weighted gradient-echo images were acquired. Image acquisition time ranged from 2 to 3 seconds. The signal intensity (SI) of brain tissue and blood vessels markedly decreased during the first pass of contrast agent through the brain due to the local field inhomogeneity caused by the concentrated paramagnetic contrast agent. The method was used in 18 subjects with no cerebrovascular disease and 32 patients with stroke, vascular stenosis, arteriovenous malformation, and cerebral neoplasm. Comparison with intracranial angiography was performed in three patients and with single-photon emission computed tomography of blood flow in four. The change in T2* relaxation rate was approximately linearly related to the dose of contrast agent. The SI change increased as the echo time was lengthened. Regions in cerebral infarcts, metastases, and arteriovenous malformations showed different enhancement patterns than those of edema around a lesion and of normal brain tissue. Abnormal circulation times in patients with vascular stenoses were demonstrated. The method provides information about cerebral blood flow dynamics not available from conventional MR imaging and MR angiography.
Adolescent↗