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Biomedical subjects

Louis A Gilula

Publications and source records attributed to Louis A Gilula.

27 records · Page 2Linked to original sources
PubMed2003

Percutaneous vertebroplasty: treatment of painful vertebral compression fractures with intraosseous vacuum phenomena.

OBJECTIVE: This study was undertaken to determine the efficacy of percutaneous vertebroplasty in treating patients with painful compression fractures of the thoracic and lumbar vertebrae that contain intraosseous vacuum phenomena. MATERIALS AND METHODS: Nineteen cases of painful vertebral compression fractures with intraosseous phenomena occurring in 18 patients (six men, 12 women; age range, 59-88 years; mean age, 75.5 years) were identified from 393 percutaneous vertebroplasties performed in 199 patients during 32 and a half months. All patients had osteoporosis, with severe vertebral compression to less than one third of the vertebral body height in 13 of 19 cases. Affected levels were T6 (n = 1), T8 (n = 2), T9 (n = 1), T11 (n = 1), T12 (n = 4), L1 (n = 5), L2 (n = 2), L3 (n = 1), L4 (n = 1), and L5 (n = 1). All cases had the typical intravertebral body vacuum cleft appearance on radiographs. Imaging and clinical features were analyzed. RESULTS: The mean volume of polymethyl methacrylate injected was 7.43 mL (range, 4.0-15.0 mL). Typically, the polymethyl methacrylate filled the intravertebral vacuum cleft. Complications during radiography consisted of minimal polymethyl methacrylate leakage into the adjacent disk (15/19 cases) and the paravertebral soft tissues (8/19 cases). No complications required surgical intervention. At clinical follow-up, pain relief was complete in eight patients (44.4%), partial in six patients (33.3%), and unchanged in four patients (22.2%). CONCLUSION: Percutaneous vertebroplasty is effective in the treatment of patients with painful vertebral compression fractures with intraosseous vacuum phenomena.

Aged↗
PubMed2002

Validation of the extensor carpi ulnaris groove as a predictor for the recognition of standard posteroanterior radiographs of the wrist.

This study was designed to establish the extensor carpi ulnaris groove (ECUG) as a reliable radiographic criterion for recognition of true neutral posteroanterior (PA) radiographs and to verify precise measurements of ulnar variance in a large cohort of patients. In 197 patients 197 wrists were evaluated with a series of radiographic views obtained during routine wrist arthrography. Posteroanterior views were taken in all patients at 90 degrees, 45 degrees, and 0 degrees arm abduction and in 171 patients at 90 degrees elbow flexion and 90 degrees arm abduction with full elbow extension. The ECUG position was classified according to its profile with the ulnar styloid as excellent, acceptable, or unacceptable. Ulnar variance was measured on all x-ray films. Statistical analysis included interobserver reliability with 100 x-ray films measured by 2 evaluators. The ECUG was excellent or acceptable in 100% of the x-rays on standard PA views (arm abducted 90 degrees ), 87% excellent or acceptable and 13% unacceptable on 45 degrees arm abduction views, and 23% excellent or acceptable and 77% unacceptable on 0 degrees arm abduction (adducted) views (all with the elbow flexed at 90 degrees ). With the arm at 90 degrees abduction and full elbow extension the ECUG was excellent or acceptable in 91% of cases. These results show that the ECUG is a reliable criterion to verify arm position during PA wrist radiography and therefore provides a standard for making treatment decisions. The need for repeat radiographs should be reduced.

Cohort Studies↗
PubMed2002

Vertebroplasty: reusable flange converter with hub lock for injection of polymethylmethacrylate with screw-plunger syringe.

During percutaneous vertebroplasty, a screw-plunger syringe provides a powerful controlled injection, but coupling of the screw plunger with interchangeable disposable standard syringe barrels results in syringe flange bending failure during the middle of the injection. A flange converter produced from stainless steel and a hub lock produced from plastic or aluminum were used during vertebroplasty at 172 levels in 86 patient-treatment sessions. The flange converter and hub lock increase the achievable volume that can be injected, can be fabricated with hand machining, and cost much less than other commercially available devices.

Adult↗
PubMed2002

Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures.

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating severe vertebral body compression fractures, or vertebra plana, in patients with osteoporosis. MATERIALS AND METHODS: In 155 patients, 310 percutaneous vertebroplasties were performed during 25 months and 15 days. Of these, 37 patients (27 women, 10 men; mean age, 73.6 years) underwent 48 vertebroplasties for severe osteoporotic vertebral body compression fractures. The fractures were defined as vertebrae that have collapsed to less than one-third of their original height. Imaging and clinical features were analyzed, including the extent of vertebral collapse, location of the involved vertebra, pattern of vertebral compression, volume of polymethylmethacrylate injected, vertebroplasty complications, and clinical outcome. RESULTS: Vertebral body collapse averaged 23% (range, 4.5%-33.0%) of the original height. Involved vertebrae were located from levels T5 to L5, with one-half affected at the thoracolumbar junction. Patterns of vertebral compression were divided into gibbus (31 of 48 or 65%), plana (13 of 48 or 27%), and H shape (four of 48 or 8%). The mean volume of the cement injected was 6.0 mL (range, 1.5-12.5 mL). Complications observed on radiographs included cement leakage to the adjacent disc (17 of 48 or 35%) and the paravertebral soft tissues (four of 48 or 8%). There were no major complications. At clinical follow-up (mean duration, 11 months and 3 days; range, 3-24 months), pain relief was complete in 14 (47%) of 30 patients, partial in 15 (50%), and unchanged in one (3%). No patient required surgery. CONCLUSION: Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures is safe and effective and should not be withheld in this group of patients.

Adult↗