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Biomedical subjects

J M Ginalski

Publications and source records attributed to J M Ginalski.

At least 19 recordsLinked to original sources
PubMed1992

[Magnetic resonance imaging of the normal and the pathological knee in the child].

The results of magnetic resonance imaging (MRI) studies performed on the knee region of 60 children including 20 normally growing subjects are reported. In healthy children, MRI permitted to study the normal maturation of bone marrow and cartilaginous structures. The patients studied had bone tumors (11 patients), rheumatoid arthritis (8 patients), lesions of traumatic origin (7 patients), osteochondritis (4 patients), vascular and tissular dysplasia (3 patients), osteomyelitis (3 patients) and soft-tissue tumors (3 patients). In all patients, MRI showed clinically relevant abnormalities that were not detected by conventional X-rays or physical examination. MRI offers the ability to study disorders of bone, bone marrow, cartilage, menisci and ligaments in a noninvasive way. MRI has replaced arthrography of the knee and is the examination of choice in pediatric patients.

Adolescent↗
PubMed1992

Magnetic resonance imaging of nontraumatic shoulder instability in children.

Nontraumatic shoulder instability is infrequent in children. We examined prospectively with high-field magnetic resonance imaging (MRI) 11 patients with this disorder, including 2 with Holt-Oram syndrome and 11 healthy control subjects. The MR findings in the glenohumeral joint in normally growing children are presented. Two patients with shoulder instability were considered as normal, one presented with type 2 (Zlatkin) labral lesions, three, type 3 and one, type 4 lesions. Close attention to the normal imaging patterns of the maturing glenohumeral joint is required to avoid pitfalls in the interpretation of the images.

Adolescent↗
PubMed1992

Is tomography of intervertebral disc calcification useful in children?

In the past ten years, we have found cervical intervertebral disc calcifications in three children on plain films of the cervical spine made because of cervical pain. In each case, we required further radiological investigations, antero-posterior and lateral linear tomography for two children and an axial computed tomography for one child. In each case, tomography revealed no supplementary useful information. On retrospect, we think that these examinations caused unnecessary irradiation and that they should only be carried out in the rare circumstances when disc calcification is associated with neurological symptoms.

Adolescent↗
PubMed1992

Use of low-osmolality contrast medium does not increase prevalence of medullary sponge kidney.

To assess the prevalence of intrapapillary linear collections of contrast medium as well as of homogeneous papillary blush on excretory urograms obtained with a low-osmolality contrast medium, iohexol was used in 300 patients. Intrapapillary linear collections of contrast medium (ie, three or more linear collections of contrast material within a papilla) were found in 10 (9.5%) of the 105 patients with renal stone disease and two (1.0%) of the 195 patients without nephrolithiasis (P less than .001). These prevalences are similar to those found in a previous study with use of a high-osmolality contrast medium (sodium amidotrizoate). The difference in the prevalence of homogeneous papillary blush between stone formers and non-stone formers was nonsignificant. The authors conclude that intrapapillary linear collections of contrast medium on excretory urograms obtained with use of a low-osmolality contrast medium should be considered to have the same clinical significance as those on excretory urograms obtained with use of a high-osmolality contrast medium, that is, as indicating the presence of medullary sponge kidney.

Adolescent↗
PubMed1992

[Respective role of the size, location and composition of the calculus as determinants of therapeutic success after extracorporeal shock wave lithotripsy in renal lithiasis].

We evaluated the respective role of size, location and composition of renal stones as determinants of the outcome of extracorporeal shock wave lithotripsy (ESWL). The analysis of the chemical composition and of the morphology of the fragments eliminated by hundred patients who underwent ESWL has been made by X-rays diffraction. Results showed that the larger the stone, the higher the risk of having to perform an extra intervention (additional sessions of ESWL, percutaneous nephrostolithotomy, nephrolitholapaxy) or of finding residual fragments at the three month check-point. In addition, the location of the stone in a calice, especially a lower calice, strongly predisposes to incomplete elimination of the fragments. Finally, two types of stones appear to lessen the probability of success of ESWL: those of struvite and those of cystine. Indeed, out of eleven ESWL performed on struvite stones (pure or mixed), two had to be completed by percutaneous nephrolitholapaxy and even one by a nephrectomy because of superinfection. Out of the four patients with cystine stones, two had to be treated by additional percutaneous nephrolitholapaxy because of inadequate fragmentation after ESWL. However, for the remaining types of stones (pure or mixed) chemical composition seems to be less important than size or location.

Cystine↗
PubMed1991

Spontaneous regression of intervertebral disc calcifications in a child.

This article presents the case of a boy who complained of cervical and thoracic spine pain for the first time at the age of nine. Plain films of cervical and thoracic spine showed calcifications of intervertebral disc C4-C5, C5-C6, C6-C7 and D3-D4. The symptoms disappeared after conservative therapy. Plain films taken 16 months later showed spontaneous disappearance of all disc calcifications. This spontaneous regression of intervertebral disc calcifications in childhood has also been described in other cases reported in the medical literature. Except for the rare cases when disc calcifications are associated with disc herniation, the discovery of disc calcifications on a plain X-ray of a child corresponds to a benign abnormality.

Calcinosis↗
PubMed1990

Does medullary sponge kidney cause nephrolithiasis?

The prevalence of medullary sponge kidney in patients with nephrolithiasis and the issue of whether or not medullary sponge kidney has a role in the pathogenesis of renal stones are controversial. We studied the excretory urograms of 280 patients with nephrolithiasis and 280 patients without either nephrolithiasis or a history of renal stones to determine the frequencies of medullary sponge kidney in the two groups. The criterion for the diagnosis of medullary sponge kidney was the presence of a minimum of three linear or round collections of contrast material within one renal papilla. In the patients with nephrolithiasis, we also looked for biochemical evidence of metabolic causes of renal stones. The frequency of medullary sponge kidney was 12% in patients with nephrolithiasis compared with 1% in patients without nephrolithiasis. The statistical difference was highly significant (chi square = 27.1; p less than .001). Metabolic disorders accounting for the lithiasis were detected in 93% of the patients with stones without medullary sponge kidney. Such evidence was present in 60% of patients with stones and medullary sponge kidney. The statistical difference was significant (chi square = 25.8; p less than .001). Our results suggest that medullary sponge kidney is a cause of nephrolithiasis.

Adult↗
PubMed1989

Cervicooccipital hinge changes during longterm hemodialysis.

A radiological survey of the upper cervical spine was carried out in all our unit cases treated by longterm hemodialysis for at least 8 years. There were 23 patients, 16 men, 7 women, whose mean age was 56.5 years. Among them, 9 had radiological changes in the cervicooccipital hinge. Bone cysts of various sizes were found in the dens (5 times), in the body of C2 (3 times) in the lateral masses of C1 (5 times) and in the anterior arch of C1 (3 times). A pauci-symptomatic odontoid fracture was demonstrated in 1 case. Only 3 patients suffered from cervical pain. Although no biopsy was performed, it is suggested that the bone cavities could be due to local amyloid deposits. beta 2 microglobulin serum levels were considerably increased in all cases.

Adult↗
PubMed1988

[So-called "renal" idiopathic hypercalciuria most often has a dietary origin].

Among renal stone formers with idiopathic hypercalciuria, patients who remain hypercalciuric despite low calcium intake have often been regarded as having a primary renal leak of calcium, i.e. renal hypercalciuria. However, at any given intake of calcium, dietary factors other than calcium can generate hypercalciuria, e.g. high intakes of sodium, of animal protein or of carbohydrates, or obesity itself. Thus, the incidence of renal hypercalciuria among stone formers has probably been overestimated. To address this issue, the aforementioned dietary and/or metabolic factors have been evaluated in 51 stone formers with idiopathic hypercalciuria refractory (i.e. U-Ca. V greater than 250 mg/24 h) to 5 days on low calcium intake (max. 400 mg/day). In 15 patients (all had U-Na. V greater than 200 mmol/24 h), U-Ca.V was within the 95% confidence limits of a nomogram U-Ca.V versus U-Na.V, suggesting that their idiopathic hypercalciuria was related, at least in part, to the high sodium intake. 7 patients had severe hyperuricosuria (greater than 1 g/24 h) suggesting high animal protein intake. 20 patients were obese (greater than 120% ideal weight) with (7 cases) or without (13 cases) concomitant fasting hyperinsulinemia (greater than 18 microU/ml). In addition, a careful retrospective analysis of intravenous pyelograms disclosed medullary sponge kidneys in 8 cases which had remained undiagnosed so far; in one of them histological confirmation was obtained after surgical removal of a renal pole and a radiologico-histological comparison. Thus, only 14 out of 51 patients had an otherwise unexplained idiopathic hypercalciuria on low calcium intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium↗
PubMed1987

Dietary factors and medullary sponge kidneys as causes of the so-called idiopathic renal leak of calcium.

Out of 89 stone formers with idiopathic hypercalciuria, 51 remained hypercalciuric on a low calcium diet over 5 days: a renal leak of calcium could thus have been suspected in them. Dietary factors such as high sodium or high animal protein intake, and metabolic factors such as obesity with or without hyperinsulinemia, which all might account for the hypercalciuria of these patients, have been evaluated. This evaluation revealed conditions known to be associated with hypercalciuria in 37 of these 51 patients: 15 had hypercalciuria related to a high sodium intake, 7 had severe hyperuricosuria (greater than 1 g/24 h) reflecting a high animal protein intake, 20 were obese (greater than 120% of ideal weight) with (7 cases) or without (13 cases) concomitant high fasting plasma level of insulin (greater than 18 microU/ml). A careful retrospective analysis of the intravenous pyelograms disclosed medullary sponge kidneys in 8 cases which had remained undiagnosed so far. One of them was studied histologically. Only 14 out of 51 patients had an otherwise unexplained hypercalciuria on a low calcium diet. It is concluded that dietary causes appear to play a key role in 'idiopathic' hypercalciuria, that the incidence of a primary renal leak of calcium among idiopathic stone formers is much smaller than initially thought, and that this condition can hide unrecognized medullary sponge kidneys.

Calcium↗
PubMed1986

Follow-up of renal morphology and growth of 141 children operated for vesicoureteral reflux: a retrospective computerized study.

This study relates the postoperative evolution after ureterovesical reimplantation for vesicoureteral reflux (VUR) in 141 children who were ten years old or younger at the time of surgery. Renal growth and morphology were evaluated 2 and 5 years after surgery. We estimated renal growth by measuring the ratio of the bipolar parenchymal thickness to the total length of the kidney. We noticed that whatever the degree of reflux might have been, most of the kidneys partially or totally compensated for their growth failure. This growth resumption required many years to be completed. Surgical correction of VUR had favorable consequences on the radiologic aspect of pyelonephritic scars only on some of the kidneys: in these cases, the child's age appeared to be the only factor that had a statistical importance affecting the postoperative evolution of pyelonephritic scarring: the younger the children were at the time of surgery, the better the results obtained.

Age Factors↗
PubMed1986

Tubulopathy in nephrolithiasis: consequence rather than cause.

To address whether a renal tubular dysfunction is encountered in a particular patient subgroup with urolithiasis, the following parameters of tubular function were measured in urine taken in the morning from 214 stone formers after fasting: pH, excretion of lysozyme and gamma-glutamyl transferase (gamma-GT); fractional excretion (FE) of glucose, insulin, Mg, K, and HCO3 after an alkali loading; and the renal threshold for phosphate (TmP/GFR). The following diagnoses were made in the patient group: primary hyperparathyroidism (N = 8), medullary sponge kidneys (N = 21), hyperuricemia (N = 10), cystinuria (N = 2), struvite stone disease (N = 6), idiopathic hypercalciuria of the absorptive (N = 25), dietary (N = 69) or renal (N = 7) type, and normocalciuric idiopathic urolithiasis (N = 66). In 31% of the patients TmP/GFR was below 0.80 mmole/liter and in 13% of the patients, FE HCO3 after alkali loading was above normal. Urinary excretion of lysozyme and that of gamma-GT both were elevated in 17% of the patients. FE glucose, FE insulin, FE Mg, and FE K were elevated in 8, 9, 3, and 7% of the patients, respectively. This study demonstrates that a significant number of stone formers present with signs of renal tubular dysfunction, primarily involving the proximal tubule since apparent leaks of phosphate and of bicarbonate were most frequently encountered. The defects were not specific for a given etiologic group of patients; on the other hand, occurrence was related to the presence of large stones in the pyelocaliceal system at the time data were gathered. Taken together these data suggest that the tubulopathy in nephrolithiasis is the consequence rather than the cause of the stone.

Adolescent↗
PubMed1985

Renal growth retardation in children: sign suggestive of vesicoureteral reflux?

Of 141 children undergoing surgery for vesicoureteral reflux detected by voiding cystourethrography, preoperative excretory urography demonstrated signs suggestive of vesicoureteral reflux in 154 (67.5%) of 228 refluxing ureter. In 48 refluxing ureters (21%) renal growth retardation was the only sign; the latter was appreciated by applying the index described by Hodson, that is, the ratio of bipolar parenchymal thickness to total renal length. It was concluded that it is important to systematically calculate this simple index from every child's excretory urogram.

Child↗