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Biomedical subjects

M Dalinka

Publications and source records attributed to M Dalinka.

17 recordsLinked to original sources
PubMed1991

Cervical paraspinal calcification in collagen vascular diseases.

Although soft-tissue calcification is common in collagen vascular disease, paraspinal calcification in the cervical spine has not been described before. We studied five women with large, lobulated, predominantly homogeneous calcific masses centered on synovial articulations in the neck. Changes consisting of either osteolysis or erosions were evident. All patients had radiculopathy, focal pain, or stiffness. In two patients, the presence of hydroxyapatite crystals was confirmed on biopsy. Symptomatic cervical paraspinal calcifications in patients with collagen vascular disease cause large soft-tissue masses that mimic tumoral calcinosis.

Aged↗
PubMed1989

Quantitative computed tomography reflects vertebral fracture morbidity in osteopenic patients.

We studied the relationship between spontaneous vertebral compression fractures and lumbar vertebral trabecular bone density in 69 consecutive patients with suspected osteopenia. Seven had biopsy-confirmed osteomalacia. The remaining 62 were divided into three groups: group 1--asymptomatic patients suspected of having osteopenia on plain films, but with no vertebral compression fractures (N = 24); group II--those with one to five vertebral compression fractures (N = 16); and group III--those with six or more vertebral compression fractures (N = 22). A quantitative computed tomographic (QCT) scan of the lumbar spine was performed on all patients. Patients in group I had QCT values of 94 +/- 23 mg/cm3 (mean +/- SE); those in group II had QCT values of 66 +/- 28 mg/cm3; and those in group III had values of 34 +/- 28 mg/cm3. There were significant differences among all groups (P less than .001), although there was considerable overlap of individuals among the groups. There was no significant difference between the mean QCT value of patients with one compression fracture and the value of those with between two and five compression fractures. Patients with biopsy-proven osteomalacia had higher vertebral trabecular bone density than patients with osteoporosis and compression fractures. Our study provides evidence suggesting a strong inverse relationship between QCT-measured vertebral bone density and the presence of vertebral compression fractures in a group of osteopenic patients.

Absorptiometry, Photon↗
PubMed1988

Osteomalacia as a very late manifestation of primary hyperparathyroidism.

An 86-year-old woman with a history of treated hyperthyroidism and a 20-year history of untreated primary hyperparathyroidism developed generalized bone pain and a pseudofracture of the midshaft of the left femur. Laboratory examinations revealed elevated serum calcium, alkaline phosphatase, and C-terminal parathyroid hormone levels. Serum inorganic phosphate was below normal and 25-hydroxyvitamin D levels were low-normal. An undecalcified transiliac bone biopsy specimen following tetracycline double labeling revealed osteomalacia and osteitis fibrosa. Following treatment with vitamin D and phosphate, the serum inorganic phosphate level rose to normal. There was a decrease in bone pain, and the pseudofracture healed. However, the serum calcium, alkaline phosphatase, and C-terminal parathyroid hormone levels remained elevated. Longstanding primary hyperparathyroidism causes chronic hypophosphatemia and may lead to osteomalacia. Osteomalacia and its consequences may be part of the spectrum of bone disease seen in patients with longstanding primary hyperparathyroidism.

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PubMed1987

MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease.

MR studies of the lumbar spine in 41 patients were analyzed at 203 disk interspaces to assess the appearance and frequency of bone marrow signal changes in the vertebral bodies adjacent to normal and degenerated disks. Degenerative changes were found at 58 interspaces; an abnormal bone marrow signal was identified in 29 (50%) of these. On spin-echo pulse sequences with short and long repetition times (TRs) and echo times (TEs), an area of relative increased signal intensity was seen in the vertebral body adjacent to the disk in 24 cases (17 were bandlike on both sides of the disk, four were focal on one side of the disk, and three were bandlike and focal on one or both sides of the disk). In one patient decreased signal was noted on both short and long TR/TE imaging. In the other four patients decreased signal was noted on short TR/TE pulse sequences and increased signal was evident on long TR/TE. These marrow changes were not present adjacent to normal disks. The relatively high signal intensity on both short and long TR/TE pulse sequences suggests that the increased signal resulted from the conversion of normal hemopoietic bone marrow to fatty marrow. We conclude that bandlike or focal areas of high signal intensity in the bone marrow adjacent to degenerated intervertebral disks occur commonly on MR images of the spine and must not be confused with signal changes from tumors or infections involving the disk space and adjacent vertebral end plates.

Adolescent↗
PubMed1986

Magnetic resonance imaging of avascular necrosis of the femoral head.

This study investigates the role of magnetic resonance imaging (MR) in identifying avascular necrosis (AVN) of the femoral head and in monitoring its therapy. The detection of AVN, particularly in its early stages, is imperative to give therapeutic intervention the best opportunity for successful management. The results of magnetic resonance imaging are compared with those of the standard diagnostic modalities in evaluation of patients with the lesion. Examinations were performed at 0.12T with a repetition time (TR) of 143 ms and times to echo (TE's) of 10 or 20 ms. This study represents a retrospective review of 90 hips which were examined in 45 consecutive patients. Of these, 52 hips were biopsied as part of treatment. MR was shown to be sensitive in the detection of AVN. Comparison of MR with radionuclide imaging showed comparable sensitivity and specificity. MR was also noted to be sensitive in the detection of early AVN. Preliminary results suggest that MR can monitor treatment of the affected hip, and may even be able to predict patient response to therapy. Although further work is necessary to determine the role of MR in the evaluation of the patient presenting with hip pain, MR is a sensitive method in detecting AVN and in monitoring its course in patients suspected of having the disease.

Adult↗
PubMed1986

Hematopoietic and fatty bone marrow distribution in the normal and ischemic hip: new observations with 1.5-T MR imaging.

The conversion of hematopoietic to fatty marrow is known to correlate with physiologic decreases in intramedullary blood flow. To determine whether the chronology of conversion is altered in patients with hip ischemia, T1-weighted magnetic resonance (MR) images of the hips in 50 healthy people and 27 with documented avascular necrosis (AVN) were reviewed. The distribution of fatty (high-signal) versus hematopoietic (low-signal) marrow was noted with respect to age. All patients had fatty marrow in the femoral capital epiphysis and greater trochanter. Hematopoietic intertrochanteric marrow was seen in 95% (80 of 84) of femurs in control subjects less than 50 years old, but in only 12.5% (two of 16) of those in control subjects older than 50 years (P less than .005). Only 33% (19 of 57) of patients less than 50 years with AVN had predominantly hematopoietic intertrochanteric marrow (P less than .005). The early conversion to fatty marrow in most patients with AVN as depicted by MR imaging may be an effect of decreased vascularity of the proximal femur and may allow the identification of patients at increased risk for AVN.

Adult↗
PubMed1986

Avascular necrosis of the femoral head: morphologic assessment by MR imaging, with CT correlation.

To better understand the morphologic appearance of avascular necrosis (AVN) of the femoral head on magnetic resonance (MR) images (1.5 T) and computed tomographic (CT) scans, the records of 21 lesions were reviewed retrospectively. All MR imaging studies included T1-weighted images (T1WI) (repetition times [TR] of 400-1,000 msec, and echo times [TE] of 20-25 msec), and 15 included T2-weighted images (T2WI) (TR = 2,000-2,500 msec; TE = 60-80 msec). MR signal features of the lesions were compared with features on the corresponding CT scans. Abnormalities in the superoanterior aspect of the femoral head were noted on both image types in all 21 lesions but were more obvious on MR images in two. A characteristic margin of peripheral sclerosis seen on CT scans in 95% (20 of 21) of lesions corresponded to a line of low intensity on MR images. Fractures complicating AVN were seen in eight lesions at CT scanning. On T1WI, fractures were not clearly delineated. On T2WI, fractures were of high intensity but were depicted less clearly than on CT scans. Central signal intensity of the lesions on T1WI correlated with the presence or absence of fracture: 88% (seven of eight) of the lesions with fractures appeared less intense than fat, compared with only 8% (one of 13) of lesions without fractures (P less than .005). While MR imaging is a sensitive method for early diagnosis of AVN, CT scanning can more accurately identify fractures and is thus important for staging.

Adult↗
PubMed1986

MRI of joint fluid in the normal and ischemic hip.

MR images in 36 hips with documented avascular necrosis and 80 hips without evidence of joint disease were studied to determine the amount and appearance of fluid in the joint. All MRI examinations were done on a 1.5-T machine and included coronal images made with relative T2 weighting (repetition times = 2000-2500 msec, echo delays = 60-100 msec). The amount of joint fluid, which had an intense signal higher than fat, was graded from 0 to 3 and analyzed with respect to the patient's age and radiographic stage of avascular necrosis. Joint fluid was seen in 84% of presumed normal hips. Only four (5%) of 80 had enough fluid to surround the femoral neck (grade 2), and none had sufficient fluid to distend the joint capsule (grade 3). In comparison, 21 (58%) of 36 hips with avascular necrosis had grade-2 or grade-3 effusions (p less than 0.005), and some fluid was seen in all. Grade-3 effusions were seen in seven (50%) of 14 hips with flattening of the femoral head, compared with only one (5%) of 20 in which the femoral contour was normal. It is concluded that small amounts of fluid are present in both normal hips and those with avascular necrosis. In avascular necrosis, increased joint fluid may be present before radiographic abnormalities occur, but it is greatest after there is flattening of the femoral head. MRI is a highly sensitive method for detecting fluid in the hip joint.

Adolescent↗
PubMed1984

Osteomalacia and osteitis fibrosa in a man ingesting aluminum hydroxide antacid.

A 53-year-old man with a history of long-term aluminum hydroxide antacid ingestion reported diffuse bone pain and multiple stress fractures over a two-year period. An undecalcified transiliac bone biopsy specimen revealed osteomalacia with osteitis fibrosa; plasma parathyroid hormone and cyclic AMP levels were normal. Following withdrawal of antacids and treatment with calcium and phosphorus, an initially elevated plasma, 1,25-dihydroxyvitamin D level fell to within the normal range, accompanied by decreased bone pain, healed stress fractures, and increased axial bone mineral content as determined by computed tomography of lumbar trabecular bone. Phosphate deprivation and 1,25-dihydroxyvitamin D excess may contribute to the poor mineralization and exaggerated resorption of bone observed in this syndrome. The clinical, biochemical, radiologic, and histologic features of previously reported cases are reviewed. Early recognition of this syndrome is important, since appropriate therapy promotes skeletal remineralization and prevents morbidity.

Aluminum Hydroxide↗
PubMed1979

Baker's cysts and true thrombophlebitis. Report of two cases and review of the literature.

We describe two patients who had knee pain and were found to have the unusual combination of a Baker's cyst and true thrombophlebitis. Since Baker's cysts can dissect along the gastrocnemius, they can cause leg pain and simulate thrombophlebitis, but they do not require anticoagulation therapy. Most of the literature implies that the two syndromes are mutually exclusive; however, our cases lend support to the fact that a dissecting popliteal cyst does not rule out the possibility of thrombophlebitis. Venography should be performed if there is any doubt as to the diagnosis.

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PubMed1975

Lymphatic visualization during hip arthrography.

Lymphatic visualization at arthrography has been reported previously in patients with rheumatoid arthritis. The authors describe this phenomenon in 4 patients undergoing arthrography of the hip following prosthetic surgery, only one of whom had a history of rheumatoid arthritis. It is suggested that lymphatic visualization is not a reliable indicator of any specific type of arthritis, but rather an ancillary sign of inflammation, and that it may occur whenever lymphatic hyperplasia or increased synovial membrane permeability is present.

Aged↗