Biomedical subjects
J H Mink
Publications and source records attributed to J H Mink.
Early experience with automated percutaneous lumbar discectomy in the treatment of lumbar disc herniation.
Seventeen patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy employing local anesthetic in an outpatient setting. Operative technique included (1) intravenous sedation and single-dose antibiotics, (2) prone oblique patient positioning for initial needle placement, and (3) postdiscectomy interspace lavage with bupivacaine hydrochloride. There were no postoperative complications and the procedure was well-tolerated by all patients. Although results have thus far been less successful than previously reported, with improved patient selection by means of routine magnetic resonance imaging (or computed tomographic discography in select cases), success rates (nine of 17 patients) might approach those achieved by chemonucleolysis. The successful response of four patients with so-called midline L4-L5 discs has been particularly encouraging, and it may be that percutaneous lumbar discectomy will be an effective and a reasonable treatment alternative for this particular subgroup of patients.
Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation.
In 242 of 3,000 patients who underwent magnetic resonance (MR) imaging of the knee between September 1986 and August 1987, original MR imaging reports were compared with subsequent arthroscopic reports to determine the value of MR imaging in the evaluation of suspected meniscal and complete tears of the anterior cruciate ligament. The overall accuracy for the menisci was 93% (sensitivity, 95%; specificity, 91%) with a false-negative rate of 4.8%. For the anterior cruciate ligament the overall accuracy was 95%. T2-weighted sequences were associated with greater sensitivity, specificity, and accuracy than were T1 sequences; the false-negative rate was 0% in the T2-weighted group. MR imaging of the knee is an extremely accurate means for noninvasive assessment of the integrity of the menisci and anterior cruciate ligament, and the accuracy exceeds that usually reported for arthrography.
Patellofemoral joint: kinematic MR imaging to assess tracking abnormalities.
The patellofemoral joint was imaged with magnetic resonance (MR) in the axial plane while the knee was positioned from 0 degrees to 32 degrees of flexion (nine positions). These multiple sequential images obtained within the early phases of flexion of the knee were viewed in a "cine-loop" format, producing a kinematic study that clearly demonstrated the relationship of the patella to the trochlear groove. Four healthy subjects and one patient with known bilateral subluxing patellae were studied. The preliminary results suggest that kinematic MR imaging of the patellofemoral joint is potentially useful for the evaluation of patellar tracking abnormalities.
Meniscal tears: pathologic correlation with MR imaging.
Menisci from 12 autopsies and above-knee amputations were imaged with magnetic resonance (MR) at 1.5 T and then sectioned for gross and histologic examination. A histologic staging system was developed and showed a one-to-one correlation with corresponding grades of MR signal intensities. Histologic stages 1 and 2 represented a continuum of degeneration culminating in stage 3 fibrocartilaginous tears, seen most frequently in posterior-horn segments of the medial meniscus. Correlation of histologic stages with MR signal intensity allows for an improved diagnostic reading of MR images.
Bone scan-positive and radiograph- and CT-negative vertebral lesion in a woman with locally advanced breast cancer.
Explore the source record for details and available documents.
Reversible cause of back pain and sciatica in rheumatoid arthritis: an apophyseal joint cyst.
Explore the source record for details and available documents.
Case report 313. Diagnosis: intrasacral cyst ("occult intrasacral meningocele").
Explore the source record for details and available documents.
Rotator cuff tears: evaluation using double-contrast shoulder arthrography.
To determine the accuracy of double-contrast arthrography in complete rotator cuff tears, we studied 805 patients thought to have a complete rotator cuff tear who had undergone double-contrast shoulder arthrography (DCSA) between 1978 and 1983. The results of this study indicate that DCSA is exquisitely sensitive and as accurate as the single-contrast examination. The site of disruption was directly visualized in 93% of cases, and the size of the defect and status of the torn tendon edges were reliably predicted. Such information may influence the surgeon in patient selection for operative repair as well as surgical approach.
Computed tomography of the glenohumeral and sternoclavicular joints.
Cross-sectional image display and high contrast resolution of computed tomography underscore the importance of this modality in the evaluation of a wide variety of abnormalities involving the glenohumeral articulation. Computerized arthrotomography provides a more comprehensive examination of the glenohumeral joint when compared with conventional arthrotomography. Furthermore, it requires less technical expertise to perform and is better tolerated by symptomatic patients. Computerized arthrotomography appears to be an ideal imaging method for evaluation of the Hill-Sachs defect and may prove to be the best imaging technique in the assessment of abnormalities of the bicipital tendon and sheath. In addition, the cross-sectional image display and wide contrast resolution of CT are well suited to the evaluation of the sternoclavicular joint.
Computed and conventional arthrotomography of the glenohumeral joint: normal anatomy and clinical experience.
The glenohumeral joint was studied in 25 cadavers and 136 patients using computed arthrotomography (CAT) and conventional arthrotomography (AT) to assess shoulder instability. Cadaver shoulders were injected with air or latex, sectioned with a band saw, and normal articular anatomy outlined. CAT was performed in 81 patients and characterized the glenoid labrum as normal, abnormal, or detached in 38 of the 44 patients who had surgery or arthroscopy (sensitivity, 96%; accuracy, 86%). Hill-Sachs defects were seen in 20 out of 29 patients with anterior labral abnormalities, while bicipital tendon abnormalities were evident on CAT in 6. Of 55 patients who had AT, the status of the labrum was clarified in 13 of the 16 patients who had surgery or arthroscopy (sensitivity, 86%; accuracy, 81%). Both methods can characterize the labrum; however, CAT is more comprehensive and appears ideal for both detection of Hill-Sachs defects and imaging the bicipital tendon. CAT requires less technical expertise and radiation than AT and is tolerated better by patients in pain.
Arthrography in recurrent dislocation of the elbow.
Explore the source record for details and available documents.
Air or CO2 for knee arthrography?
Both air and carbon dioxide (CO2) have been advocated for use as the negative agent in double-contrast knee arthrography. In 39 patients examined, 40 knee arthrograms were obtained, using CO2 as the negative agent for 20 studies and room air in the other 20. In addition, the change in pH of the joint fluid was measured. Of the 20 patients in the CO2 group, 12 had pain, five of whom described it as severe. Of the 20 in the air group, two reported only moderate discomfort. Regardless of the gas used, the incidence of pain was directly related to the amount of decrease in pH. Air is believed superior to CO2 primarily because it produces less pain, persists in the joint longer (allowing for refilming), costs less, and is readily available.
The use of computed tomography to evaluate suspected mediastinal tumors.
Thirty patients with suspected mediastinal tumors were evaluated by computed tomography (CT) at UCLA Medical Center. Twenty patients with myasthenia gravis were examined for possible thymomas, benign and malignant; and 10 patients were studied for other mediastinal masses (including teratoma, seminoma, mediastinal lipomatosis, carcinoma, lymphoma, and paravertebral abscess). The CT scan was found useful in several respects: (1) yielding information not available by conventional radiographic techniques; (2) defining the anatomical location and extent of mediastinal tumors; (3) detecting pulmonary metastasis and involvement of mediastinal nodes in cases of malignancy; and (4) establishing the diagnosis of benign mediastinal fatty masses. On the basis of our early experience, we believe CT is a valuable adjunct in the preoperative assessment of patients with suspected mediastinal tumors.
Unusual case of metastatic pulmonary calcification.
Explore the source record for details and available documents.
Evaluation of glenoid labrum by double-contrast shoulder arthrography.
Double-contrast shoulder arthrography was used to define the normal and abnormal arthrographic anatomy of the glenoid labrum. A retrospective study of 12 patients suspected of having labral abnormalities or who had unexplained shoulder disability consistent with capsular laxity was undertaken. In four of the nine patients with abnormal arthrograms, the study revealed critical anatomic alterations not detectable on physical examination or pain radiographs.
Carpal involvement in inflammatory (erosive) osteoarthritis.
Inflammatory or erosive osteoarthritis, in addition to the classical digital distribution, may involve the carpus. Characteristic carpal changes are restricted to the radial aspect of the wrist and consist of narrowing, eburnation, osteophytosis, and mild subluxation of the first carpometacarpal and trapezio-scaphoid joints. Radiographic findings and differential diagnosis are discussed.
Computed tomography in the evaluation of mediastinal lipomatosis.
Mediastinal abnormalities can present a challenging differential diagnosis. One of the many causes of superior mediastinal widening is excess deposition of fat or mediastinal lipomatosis. Mediastinal widening was evaluated by routine chest radiography, conventional tomography, and computed tomography in four patients with steroid induced Cushing's syndrome or simple obesity. Computed tomography was the only modality that definitively diagnosed mediastinal lipomatosis in each case.