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Biomedical subjects

J M Lieberman

Publications and source records attributed to J M Lieberman.

At least 37 records · Page 2Linked to original sources
PubMed1995

The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury.

OBJECTIVE: Determine if laparotomy further destabilizes an unstable pelvic injury and increases pelvic volume, and if reduction and stabilization restores pelvic volume and prevents volume changes secondary to laparotomy. DESIGN: Cadaveric pelvic fracture model. MATERIALS AND METHODS: Unilateral open-book pelvic ring injuries were created in five fresh cadaveric specimens by directly disrupting the pubic symphysis, left sacroliac joint, and sacrospinous and sacrotuberous ligaments. Pelvic volume was determined using computerized axial tomography for the intact pelvis, disrupted pelvis with both a laparotomy incision opened and closed, and disrupted pelvis stabilized and reduced using an external fixator with the laparotomy incision opened. MEASUREMENTS AND MAIN RESULTS: The average volume increase in the entire pelvis (from the top of the iliac crests to the bottom of the ischial tuberosities) between a nonstabilized injury with the abdomen closed and then subsequently opened was 15 +/- 5% (423 cc). The average increase in entire pelvic volume between a stabilized and reduced pelvis and nonstabilized pelvis, both with the abdomen open, was 26 +/- 5% (692 cc). The public diastasis increased from 3.9 to 9.3 cm in a nonstabilized pelvis with the abdomen closed and then subsequently opened. Application of a single-pin anterior-frame external fixator reduced the pubic diastasis anatomically and reduced the average entire and true (from the pelvic brim to the ischeal tuberosities) pelvic volumes to within 3 +/- 4 and 8 +/- 6% of the initial volume, respectively. CONCLUSIONS: We believe that the abdominal wall provides stability to an unstable pelvic ring injury via a tension band effect on the iliac wings. Our results demonstrate that a laparotomy further destabilized an open-book pelvic injury and subsequently increased pelvic volume and pubic diastasis. This could potentially increase blood loss from the pelvic injury and delay the tamponade effect of reduction and stabilization. A single-pin external fixator prevents the destabilizing effect of the laparotomy and effectively reduces pelvic volume. These data support reduction and temporary stabilization of unstable pelvic injuries before or concomitantly with laparotomy.

Aged↗
PubMed1994

Ultrasound detection of abscesses in the temporomandibular joint following surgical reconstruction.

The purpose of this investigation is to report the technique and assess the utility of ultrasound diagnosis of abscess in the postoperative temporomandibular joint (TMJ). Fourteen patients had 18 ultrasound examinations of the postoperative temporomandibular joint (TMJ) to detect a possible abscess. Ultrasound examinations were performed with either a 5-MHz linear array and/or a 7.5-MHz sector probe following placement of implants (16) and autogenous costochondral grafts (2). The TMJ was scanned in both coronal and axial planes. In 14 examinations, an abscess was not detected; there were no false-negatives. Soft-tissue edema was found in 1 of these 14 examinations; at surgery, there was no abscess. Four examinations were positive for an abscess; 3 of these were confirmed at surgery. One examination was false-positive. We conclude that ultrasonography can detect an abscess in the symptomatic postoperative TMJ. A negative examination is reliable.

Abscess↗
PubMed1994

Paradoxical enlargement or development of intracranial tuberculomas during therapy: case report and review.

Intracranial tuberculomas can sometimes develop or increase in size despite administration of appropriate therapy. We report the case of a child whose intracranial tuberculomas paradoxically enlarged while therapy was being administered, and we review 23 other cases in which tuberculomas increased in size or number and 17 cases in which tuberculomas appeared during therapy. These phenomena generally occurred within 3 months of the start of therapy. All but four patients had neurological deterioration that prompted obtaining a repeated computed tomographic scan. One patient died, about one-fourth of patients had residual neurological symptoms, and less than one-third of the patients required surgical intervention. Most patients received a 12-18 month course of antituberculous therapy. Adjunctive therapy with steroids appears to diminish neurological symptoms and may improve outcome. Paradoxical enlargement or development of tuberculomas usually does not represent failure of antituberculous therapy; the most likely explanation for these phenomena is an interaction between the host's immune response and the direct effects of mycobacterial products.

Antitubercular Agents↗
PubMed1994

Evaluation of tibial plateau fractures: efficacy of MR imaging compared with CT.

OBJECTIVE: CT is often used after plain films to evaluate fractures of the tibial plateau. Because MR imaging can show associated soft-tissue injuries as well as fractures, we hypothesize that MR is superior to CT for imaging these injuries. Accordingly, we compared the efficacy of MR imaging and CT in 22 patients with tibial plateau fractures. SUBJECTS AND METHODS: CT with two-dimensional reconstruction and MR examinations were performed in 22 patients with tibial plateau fractures. The images were interpreted by four radiologists and two orthopedic surgeons. Findings on CT scans and plain films were used to determine the configuration of the fractures and to classify them according to the Schatzker system. This was done with findings on MR images and plain films at a separate session. The MR images were also evaluated for ligamentous and meniscal injuries. A qualitative side-by-side comparison of two-dimensional CT scans and MR images for depiction of fracture configuration was done. Imaging results were correlated with observations from physical examinations in all patients and with surgical findings in 12 patients. RESULTS: All of the six types of fractures of the Schatzker classification were observed in this series. Comparison of two-dimensional CT reconstructions and MR images for depiction of fracture configuration revealed that the two techniques were equal in 14 patients, MR imaging was superior to CT in five patients, and CT was superior to MR imaging in three patients (who had very complex and comminuted fractures). In addition, MR imaging showed 12 complete ligamentous tears and 15 partial ligamentous tears in 15 (68%) of the 22 patients. MR showed meniscal injuries in 12 (55%) of the 22 patients. CONCLUSION: MR imaging was equivalent or superior to two-dimensional CT reconstruction for depiction of fracture configuration in most patients. In addition, MR showed significant soft-tissue injuries. We believe that MR imaging is the preferable imaging technique for most patients with fractures of the tibial plateau.

Adult↗
PubMed1994

Rotavirus and other viral causes of gastroenteritis.

Diarrheal diseases are a major cause of childhood morbidity and mortality worldwide. Viruses are the leading cause of diarrhea, and rotavirus is the major cause of severe dehydrating diarrhea in both developed and developing countries. Children with viral gastroenteritis generally present with watery non-bloody diarrhea, often with vomiting and low grade fever. Disease is self-limited and treatment is simple--fluid and electrolyte replacement, preferably via the oral route, with early refeeding. While various adjunctive therapies, such as bismuth subsalicylate and oral immunoglobulins, appear promising, they cannot be routinely recommended at this time. Prevention is the key: by good personal hygiene--particularly good handwashing, by maintaining safe water supplies, and in the future, by an effective rotavirus vaccine.

Adenoviridae Infections↗
PubMed1994

Bacterial resistance in the '90s.

The lesson of the antibiotic era is, the microbe always wins. Pediatricians need to understand why, to take the threat seriously, and to mobilize to fight back.

Anti-Bacterial Agents↗
PubMed1993

Gastrointestinal radiology: current indications and referral patterns.

To determine the current indications and referral patterns for routine gastrointestinal radiology examinations, 1000 consecutive patients were prospectively analyzed. The following specialties were the largest sources of referral: general internal medicine (38%), gastroenterology (21%), and general and colorectal surgery (17%). Referrals from gastroenterologists were weighted toward areas not well evaluated by endoscopy, such as suspected small bowel disease. The major indications for upper gastrointestinal (GI) examinations were dysphagia and swallowing disorders (32%), hiatus hernia/reflux (14%), and ulcer (14%). Small bowel series were predominantly performed for inflammatory bowel disease (37%), obstruction (25%), and occult blood loss (18%). The majority of combined upper GI/small bowel studies were performed for indications primarily relating to the small bowel. Forty percent of barium enemas were performed for detection of neoplasms and polyps, with pain/irritable colon (14%) and exclusion of leak (14%) the next most common indications. Traditional indications, such as peptic ulcer disease and neoplastic disease, continue to be sources of referral for gastrointestinal radiology. However, more specialized applications, particularly in areas not well suited to endoscopy, such as swallowing disorders, inflammatory disease of the small bowel, and evaluation of surgical anastomoses, are also being commonly used. The changing indications, along with the previously documented decreased volume of gastrointestinal radiologic procedures, should be kept in mind when planning a radiology resident educational curriculum.

Digestive System↗
PubMed1992

MR imaging of the juvenile temporomandibular joint: preliminary report.

Thirty-two children were evaluated by means of medical history and physical examination for signs and symptoms of internal derangement (ID) of the temporomandibular joint (TMJ) and mandibular dysfunction. These children also underwent magnetic resonance (MR) imaging of the TMJs. The study was double blind. At clinical examination, 19 patients (59%) had at least one positive finding of ID of the TMJ and/or mandibular dysfunction. MR images of the TMJ obtained in 60 of the 64 TMJs demonstrated 57 normal joints (95%) and three abnormal joints (5%). Two of these three joints had a mild anterior-lateral disk displacement, and one joint had an anterior dislocated disk. There were no false-positive MR examinations. MR imaging failed to depict abnormalities in 16 patients who had positive findings at history and/or physical examination. Although MR imaging may fail to depict ID of the TMJ in some patients, clinical techniques commonly used in population surveys probably overstate the prevalence of ID of the TMJ in children.

Adolescent↗
PubMed1990

Dermal grafts of the temporomandibular joint: postoperative appearance on MR images.

Complications may follow meniscectomy and placement of an allogenic implant in temporomandibular joint (TMJ) dysfunction. To characterize the anatomy of autogenous dermal grafts for repair and repositioning of the meniscus, the authors performed T1-weighted magnetic resonance (MR) imaging of 20 TMJs in 10 patients 6-23 months after surgery that was considered successful. MR imaging did not enable detection of the dermal grafts. Comparison of preoperative and postoperative MR images revealed little, if any, change in meniscal position. MR images of 20 menisci revealed anterior displacement (n = 11), normal position (n = 4), focal areas of increased signal intensity (n = 4), fragmentation (n = 2), and suboptimal visualization (n = 5). MR images of 20 condyles revealed normal features (n = 11), erosions (n = 2), early avascular necrosis (AVN) or subchondral cysts (n = 2), AVN (n = 3), an osteophyte (n = 1), and loss of bone (n = 2). One TMJ demonstrated increased soft tissue in the bilaminar zone.

Adolescent↗
PubMed1990

Prevention of bacterial meningitis. Vaccines and chemoprophylaxis.

The morbidity and mortality caused by bacterial meningitis remains significant despite advances in antimicrobial therapy and supportive care. Prevention of meningitis by routine immunization of infants, who are at greatest risk, offers the only practical way of reducing the incidence of this disease. Widespread use of the recently developed protein conjugate vaccines against Haemophilus influenzae type b by itself could reduce the incidence of bacterial meningitis in the U.S. by more than half. To prevent disease caused by the other pathogens, an effective vaccine against the group B meningococcus must be developed, and the immunogenicity of the pneumococcal and quadrivalent meningococcal vaccines should be improved. Until such time that universal immunization of infants with highly immunogenic vaccines is possible, continued efforts must focus on targeting immunization at high-risk individuals and using chemoprophylaxis to prevent secondary disease where indicated. Addendum: On October 4, 1990, the U.S. Food and Drug Administration licensed the praxis Haemophilus influenzae type b-protein conjugate vaccine (Hboc) for use in infants at 2, 4, and 6 months of age with a booster dose at 15-18 months. Physicians are directed to statements by the Immunizations Practices Advisory Committee and the American Academy of Pediatrics for official recommendations concerning its use.

Anti-Bacterial Agents↗
PubMed1988

Magnetic resonance imaging of ruptured Baker's cyst.

The clinical presentation of a ruptured Baker's cyst and of thrombophlebitis can be identical. Venography, arthrography, and more recently ultrasonography have been used to differentiate these two entities. We report a patient with a ruptured Baker's cyst who was also evaluated using magnetic resonance imaging (MRI). The soft-tissue abnormalities were better demonstrated by MRI than by the other imaging methods.

Adolescent↗
PubMed1987

Hemophilic arthropathy: assessment with MR imaging.

Fifteen patients with hemophilia, 14 of whom had hemophilic arthropathy, were examined with magnetic resonance (MR) imaging to determine if it could be used to assess hemophilic arthropathy, especially synovial hypertrophy and the status of the articular cartilage. Thirty-five joints of the appendicular skeleton were imaged. Four joints in two patients were clinically normal. Synovial hypertrophy was detected in 28 joints and appeared as areas of low to intermediate signal intensity on T1- and T2-weighted images, with foci of increased signal intensity on T2-weighted images (presumed to be due to areas of fluid or inflammation) in 16 joints. Abnormal articular cartilage was demonstrated in 26 joints; bone lesions, fluid collections, and joint space narrowing could also be seen. MR imaging appears to be useful in depicting the components of hemophilic arthropathy.

Cartilage, Articular↗
PubMed1987

Juvenile rheumatoid arthritis: assessment with MR imaging.

Thirty-three joints of the appendicular skeleton in 15 children with juvenile rheumatoid arthritis were examined with magnetic resonance (MR) imaging to determine if it could demonstrate synovial hypertrophy and status of the articular cartilage. Presumed synovial hypertrophy was seen in 13 joints as masses of varying sizes of low to intermediate signal intensity on T1- and T2-weighted images; sometimes foci of increased signal intensity, most likely due to fluid or inflammation, were seen on T2-weighted images. Probable abnormal articular cartilage was detected in ten joints, and MR imaging also demonstrated epiphyseal overgrowth, bone erosions, joint effusions, and joint space narrowing. Because MR imaging appears to provide an objective method of evaluating both synovial hypertrophy and status of articular cartilage, it may prove to be useful in monitoring progression of juvenile rheumatoid arthritis and response to therapy.

Adolescent↗
PubMed1984

Gated magnetic resonance imaging of the normal and diseased heart.

Gated cardiac magnetic resonance (MR) images were obtained in two normal volunteers and 21 adults with a variety of cardiovascular abnormalities. The images were correlated with data from clinical examinations, electrocardiograms, and cardiac catheterization. Gated cardiac images were superior to nongated images. Combined cardiac and respiratory gated images were superior to images obtained with cardiac gating only, but acquisition time was longer. Portions of the coronary arteries were visualized in seven of 23 examinations (30%), and subacute and old myocardial infarcts were seen in five of nine patients (55%) as areas of thinned myocardium. No signal changes were observed in the patients with subacute infarctions or the patient with myocarditis. Coronary atherosclerotic lesions were not visualized in any of the patients. Normal cardiac anatomy (chambers, valves, and papillary muscles) was well visualized. Examples of aortic stenosis and atherosclerosis of the abdominal aorta are shown.

Aortic Valve Stenosis↗
PubMed1984

Magnetic resonance imaging of the heart.

Magnetic resonance (MR) has noninvasively imaged the proximal coronary arteries, areas of infarction, and a variety of congenital heart lesions. Further technical improvement may extend cardiac MR from the realm of research to clinical utility.

Adult↗
PubMed1983

Computed tomography of diverticulitis.

Computed tomography (CT) is capable of imaging diverticulitis of the colon. Localized wall thickening, soft tissue density in the pericolic fat, and large soft tissue masses that may or may not contain gas have been observed in diverticulitis. Because of its noninvasive nature, CT may have an advantage in the acute phase of diverticulitis when there may be reluctance to do a barium enema. More experience will be needed to see if CT will be predictive of a need for surgery.

Aged↗