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J A Lemmens

Publications and source records attributed to J A Lemmens.

At least 19 recordsLinked to original sources
PubMed2001

Fibrous dysplasia of bone: management and outcome of 20 cases.

BACKGROUND AND OBJECTIVES: Fibrous dysplasia of bone is difficult to manage because of its variable clinical course with many different methods of treatment reported. Therefore we report on our experience. METHODS: We reviewed a series of 20 patients with 32 lesions included. The average age at the time of diagnosis was 32 years for monostotic disease, 26 years for polyostotic disease, and 3 years for McCune-Albright syndrome. The median follow-up period was 6 years. Functional and radiographic outcomes were scored. RESULTS AND CONCLUSIONS: Monostotic disease mostly presented with a circumscribed lesion and monitoring was often sufficient. Symptomatic circumscribed lesions showed satisfactory outcome when treated with curettage, cryosurgery and bone grafting. Lesions of the extended type were most of all seen in polyostotic disease and eventually needed operative treatment. In case of bony deformity, corrective osteotomies and rigid internal fixation were performed in addition to curettage, cryosurgery, and bone grafting. In polyostotic disease, expected outcomes were good, but in McCune-Albright syndrome, results were uniformly poor. J. Surg. Oncol. 2001;76:157-166.

Adolescent↗
PubMed2000

Scintigraphic evaluation of experimental chronic osteomyelitis.

UNLABELLED: Assessment of disease activity and disease extent in chronic osteomyelitis remains a difficult diagnostic problem. Radiography is not particularly sensitive. Scintigraphic techniques can be more helpful, but the routinely available agents lack specificity (99mTc-methylene diphosphonate [MDP], 67Ga-citrate) or are laborious to prepare (111In-leukocytes). We evaluated the performance of 2 new radiopharmaceuticals, 99mTc-polyethyleneglycol (PEG) liposomes and 99mTc-hydrazinonicotinamide (HYNIC)-immunoglobulin G (IgG), in an experimental model of chronic osteomyelitis. METHODS: Chronic osteomyelitis was induced in rabbits by inserting S. aureus into the right reamed and washed femoral canal. The canal was closed with cement. A sham operation was performed on the left femur. Routine radiographs were obtained immediately after surgery and before scintigraphy. Four weeks after surgery, each rabbit was injected with 37 MBq 99mTc-PEG liposomes, 99mTc-HYNIC-IgG, and 99mTc-MDP on 3 consecutive days and imaged up to 4 (MDP) or 22 (liposomes and IgG) h after injection. On day 4, rabbits received either 18 MBq 111In-granulocytes or 67Ga-citrate and were imaged up to 44 h after injection. Uptake in the infected femur was determined by drawing regions of interest. Ratios of infected-to-sham-operated femur were calculated. After the last image, the rabbits were killed, and the left and right femur were scored for microbiologic and histopathologic evidence of osteomyelitis. RESULTS: 99mTc-PEG liposomes and 99mTc-HYNIC-IgG correctly identified all 6 rabbits with osteomyelitis. 11In-granulocytes and 67Ga-citrate gave equivocal results in 1 infected rabbit. 99mTc-MDP missed 1 case of osteomyelitis. The uptake in the affected region did not differ significantly between the agents, although 99mTc-MDP tended to have higher values (MDP, 4.75 +/- 1.23 percentage injected dose per gram [%ID/g]; 67Ga, 2.05 +/- 0.54 %ID/g; granulocytes, 1.56 +/- 0.83 %ID/g; liposomes, 1.75 +/- 0.76 %ID/g, and IgG, 1.96 +/- 0.27 %ID/g). The ratios of infected-to-normal femur were also not significantly different for the respective radiopharmaceuticals. Radiography visualized only severe osteomyelitis. CONCLUSION: In this rabbit model, 99mTc-PEG liposomes and 99mTc-HYNIC-IgG performed at least as well as 111In-granulocytes and 67Ga-citrate in the localization of chronic osteomyelitis. The ease of preparation, the better image quality, and the lower radiation dose suggest that 99mTc-PEG liposomes and 99mTc-HYNIC-IgG might be suitable alternatives for 67Ga-citrate and 111In-granulocytes in the scintigraphic evaluation of osteomyelitis.

Animals↗
PubMed1999

Swelling of hand and forearm caused by Mycobacterium bovis.

A 75-year-old native Dutch farmer presented with a painless swelling of his right hand extending into his forearm, accompanied by general malaise and low grade fever. His medical history revealed coxitis tuberculosa in 1954 and injury of the same hand in 1978. His present swelling appeared to be caused by Mycobacterium bovis, probably due to endogenous reactivation. Whether the mycobacteria reached the hand hematogenously or were directly inoculated at the time of injury of his hand in 1978 remains unclear.

Aged↗
PubMed1998

Nontuberculous mycobacterial bursitis and arthritis of the shoulder.

A 56-year-old woman with systemic lupus erythematosus developed septic arthritis and bursitis of the left shoulder due to an atypical mycobacterium, M. xenopi. Plain radiography, ultrasound (US), and MRI were performed. Articular disease by tuberculous and nontuberculous mycobacteria have similar presentations, clinically as well as radiologically, and have to be differentiated from other chronic bacterial or fungal infections, pigmented villonodular synovitis, rheumatoid arthritis, gout, hemophilia, and synovial chondromatosis. Although atypical mycobacterial involvement of the skeleton and soft tissues is relatively uncommon, its incidence is increasing, as is the incidence of extrapulmonary tuberculosis in western countries. The triad of Phemister is reemphasized, and the US and MRI findings are demonstrated. The definitive diagnosis has to be made by culturing biopsied synovium or synovial fluid.

Arthritis, Infectious↗
PubMed1998

Synovial sarcoma: oncological and functional results.

AIM: To evaluate the oncological and functional result of the treatment of patients with a synovial sarcoma. This paper gives a retrospective review of 20 patients (15 male and five female) treated for synovial sarcoma at the Nijmegen University Hospital, The Netherlands. METHODS: The median age of the patients was 30 years (range: 14-71, mean 37 years). RESULTS: The tumour locations were: lower extremity in 12 patients; upper extremity in three; pelvic and groin region in four; and the retroperitoneal space in one. Surgical stages according to Enneking (Clin Orthop 1986; 204: 9-24) were IIA in five cases; IIB in seven; and IIIB in eight. The surgical margin was intralesional in three cases; marginal in three; wide in six; and radical in six. In one case the surgical margin could not be assessed and one patient was not operated. One patient developed a recurrent tumour and one developed nodal metastases. Eight patients who did not have metastases at the time of diagnosis developed metastase during follow-up. Fourteen patients died of metastatic disease; one patient died of diabetes; one is alive with disease; and four presently do not have evidence of disease. CONCLUSIONS: The outcome was poor, especially due to the occurrence of pulmonary metastases. The functional result according to the MSTS was 100% in four patients; in one the result was 93% because of the scar and venous insufficiency.

Adolescent↗
PubMed1998

Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery.

AIMS: To shed light on the controversy surrounding the methods of evaluating, staging and final treatment of intramedullary chondroid lesions. Controversy particularly exists for enchondroma and low-grade chondrosarcoma located in the extremities, because their accurate distinction is hampered by their radiographical and histological similarity. METHODS: Since 1991 we have treated 22 patients (mean age: 39.6 years) with 26 lesions (three chondroblastomas, 14 enchondromas and nine grade 1 chondrosarcomas) with curettage, cryosurgery and bone grafting. RESULTS: After a mean follow-up of 26 months no recurrences were observed. Complications consisted of two post-operative fractures, one wound infection and one intraoperative venous gas embolism. All bone grafts incorporated, resulting in full weight-bearing capacity and excellent functional results. CONCLUSION: The usefulness of a combination of curettage and cryosurgery as adjuvant therapy is considered to be equal to marginal resection according to orthopaedic oncological principles. The pre-operative assessment of these lesions and cryosurgical technique is described in detail.

Adult↗
PubMed1998

Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics.

OBJECTIVE: To determine to what extent articular, kinesiological, and psychological factors each contribute to pain and disability in patients with osteoarthritis (OA), after controlling for other factors. METHODS: Cross sectional study among 200 patients with OA of the hip or knee. Dependent variables include pain (visual analog scale), self-reported disability (questionnaire), and observed disability (performance of standardized tasks). Independent variables include joint degeneration (radiographs), muscle strength (dynamometer), range of joint motion (goniometer), pain coping (behavioral and cognitive strategies), and psychological well being (depression, anxiety, cheerfulness). Multiple regression analysis was used. RESULTS: Pain was found to be associated with muscle weakness and pain coping (p < 0.05). Disability was associated with muscle weakness, range of joint motion, pain, pain coping, and psychological well being (all p < 0.05). Both pain and disability were most strongly associated with kinesiological characteristics and pain coping. CONCLUSION: After controlling for the other characteristics, kinesiological and psychological characteristics in patients with OA are each associated with disability. The association with pain is less clear. Future research on mechanisms underlying these associations is warranted.

Adult↗
PubMed1998

Eosinophilic granuloma of bone: results of treatment with curettage, cryosurgery, and bone grafting.

Intralesional instillation of steroids is currently the first choice of treatment for eosinophilic granuloma of bone. However, some lesions fail to respond or are unsuitable for injection therapy due location, pending pathologic fracture, and soft tissue intrusion. The authors treated six patients with these lesion characteristics using curettage, cryosurgery, and bone grafting. After a mean follow-up of 34.3 months, all lesions healed completely, although one femoral fracture occurred 8 months after the operation. In selected cases of eosinophilic granuloma of bone, a primary surgical treatment seems feasible. The use of cryosurgery as adjuvant treatment extends the surgical margin and is of value in averting local recurrence.

Adult↗
PubMed1998

The effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a randomized clinical trial.

OBJECTIVE: To determine the effectiveness of exercise therapy in patients with osteoarthritis (OA) of the hip or knee. METHODS: A randomized single blind, clinical trial was conducted in a primary care setting. Patients with hip or knee OA by American College of Rheumatology criteria were selected. Two intervention groups were compared. Both groups received treatment from the patients' general practitioner, including patient education and medication if necessary. The experimental group also received exercise therapy from a physiotherapist in primary care. The treatment period was 12 weeks. The main outcome measures were pain, medication use (nonsteroidal antiinflammatory drugs, NSAID) and observed disability. RESULTS: A total of 201 patients were randomized. Exercise therapy was associated with a reduction of pain in the past week (difference in change -17.0; 95% CI -23.6, -10.4) and observed disability (-0.19; 95% CI -0.38; -0.01). Effect sizes were medium (0.58) and small (0.28), respectively. No effect of exercise therapy was found for the use of NSAID. Additional beneficial effects (p = 0.05) were found for the use of paracetamol (effect size 0.33), global effect as perceived by the patient (effect size 0.68), and muscle strength of the hip (effect size 0.34). CONCLUSION: After 12 weeks, exercise therapy is effective in reducing pain and disability. The size of the effects is medium and small, respectively.

Aged↗
PubMed1997

Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting.

We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to 154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture. We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required. We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.

Adolescent↗
PubMed1996

Nuclear arthrography: combined scintigraphic and radiographic procedure for diagnosis of total hip prosthesis loosening.

UNLABELLED: Radiographic arthrography and bone scintigraphy are common diagnostic procedures used for evaluating total hip prostheses. In this study, both techniques are combined, and nuclear contrast imaging (nuclear arthrography) is added. The efficacy of the procedures is evaluated. METHODS: After intravenous injection of 99mTc-methylene diphosphonate (MDP), standard radiographic arthrography was performed in 105 patients (107 prostheses). The radiographic contrast medium was mixed with insoluble 111In-colloid (5 MBq/20 ml). After completion of the radiographic arthrography, nuclear arthrography was performed, and multiple-view dualisotope images (111In, 247-keV peak only) were recorded. Images were interpreted by superposition of the 111In image and the corresponding 99mTc-MDP image, the latter serving as a landmark for the position of the prosthesis and osseous structures. Findings at surgery were used as the gold standard. RESULTS: In both cemented and uncemented acetabular and femoral components, nuclear arthrography performed better than or equal to radiographic arthrography (70%-90% and 60%-75%, respectively). Nuclear arthrography had higher diagnostic accuracy than 99mTc-MDP images alone. CONCLUSION: Nuclear arthrography is a sensitive technique for detection of loosening of prostheses, offering added value over radiographic arthrography and bone scanning alone, especially for evaluation of the femoral component. Radiographic arthrography remains necessary not only for adequate deposition of contrast agents but also for detailed evaluation of osseous structures.

Cementation↗
PubMed1996

Prolonged treatment with oral retinoids in adults: no influence on the frequency and severity of spinal abnormalities.

It is generally accepted that the spine is the site of predilection for retinoid-induced skeletal abnormalities. However, the reported prevalence of skeletal problems varies widely. To investigate the frequency and severity of retinoid-induced spinal abnormalities, all records of patients who underwent spinal radiographs at the request of the department of dermatology between 1983 and 1993 were reviewed. This group of 135 patients comprised the total population of retinoid-treated patients and those patients who were investigated for possible future retinoid treatment. The mean treatment period in the total group was 30 months and the mean cumulative dose of retinoid was 31 g. In 50 patients the treatment period was > or = 24 months with 30 patients being treated for more than 48 months. Baseline radiographs were available from 26 patients and these were compared with the most recent X-rays during treatment. The mean treatment period in this 'prospective group' was 25 months and the mean cumulative dose of retinoid was 25 g. The prevalence of diffuse idiopathic skeletal hyperostosis (DISH), degenerative changes and osteoporosis in the total group was respectively 16%, 53% and 29%. There was no statistically significant relation between the duration of treatment or the cumulative dose and the prevalence or severity of DISH, degenerative changes and osteoporosis. Only the age of the patients was significantly related to the frequency and severity of skeletal abnormalities. In the 'prospective group', again, no important changes were observed between the radiographs at baseline and during treatment. In this study no relation whatsoever between spinal abnormalities and prolonged oral retinoid treatment could be established. The performance of annual routine spinal radiographs during retinoid treatment is not necessary in our opinion. Additional controlled and prospective studies on spinal and extraspinal skeletal abnormalities are required to develop definitive screening guidelines for patients submitted to long-term retinoid treatment.

Acitretin↗
PubMed1995

[Chronic recurrent multifocal osteomyelitis].

In a 9-year-old girl chronic recurrent multifocal osteomyelitis was diagnosed, a rare disease mostly affecting children of which the aetiology remains obscure. It is usually diagnosed around the age of II years. The patient suffers from exacerbations and remissions for an average of 2.9 years. Awareness and recognition of the disease is of importance to avoid unnecessary diagnostic procedures and treatment. The prognosis is good.

Child↗
PubMed1995

Ewing's sarcoma of bone: oncologic and functional results.

This paper describes 29 patients with Ewing's sarcoma of bone treated between 1975 and 1990 at the University of Nijmegen Hospital, Nijmegen, The Netherlands. Osteomyelitis was the primary diagnosis in 24%. Treatment consisted of chemotherapy in combination with surgery and/or radiotherapy. Nine patients received radiotherapy only; five of them died of disease. Five patients underwent an intralesional excision; four of them died of disease. Twelve patients underwent a wide excision; there is no evidence of disease in any of them. Three patients underwent a radical disarticulation; all died of disease. The disease-free survival at 1.5 years was 66%. This figure at 5 years was 55%. After wide excision and reconstruction in tumors of expendable, femoral or radial bones good functional results were obtained in all cases.

Adolescent↗
PubMed1995

Grading medial collateral ligament injury: comparison of MR imaging and instrumented valgus-varus laxity test-device. A prospective double-blind patient study.

PURPOSE: The role of MR imaging in grading medial collateral ligament (MCL) injury of the knee in comparison to other grading methods (clinical findings and instrumental measurement) is hardly documented in the literature. The purpose of this study is to compare the results of MR imaging in grading acute MCL injuries to the results of a clinical grading by an instrumented valgus-varus laxity tester (VVLT). MATERIALS AND METHODS: Twenty-one patients clinically suspected of acute MCL injury were tested by VVLT, a well documented and instrumented test-device. All patients subsequently underwent MR imaging of the knee. MCL injury was graded independently by VVLT and MR imaging using a classification method with reference to Petermann. RESULTS: Nineteen patients had corresponding grading results by VVLT and MR imaging (kappa, 0.83; S.E., 0.10); 14 patients had a Grade I, four a Grade II and two patients had a Grade III MR imaged MCL injury. Associated lesions were also depicted on MR imaging (bone contusion (n = 3), ACL disruption (n = 2) and medial meniscal rupture (n = 1)). CONCLUSIONS: This study shows a very high degree of agreement between the results in grading acute MCL injuries with MR imaging and an instrumented valgus-varus laxity tester (VVLT). MR imaging depicted important, clinically undetected, additional lesions which can determine the treatment of MCL injury.

Anterior Cruciate Ligament↗