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M J Pais

Publications and source records attributed to M J Pais.

At least 19 recordsLinked to original sources
PubMed1990

Scaphoid fracture: evaluation with flexion-extension tomography.

Assessment of healing of a scaphoid fracture, which may be associated with delayed fusion and nonunion, is a challenging task for the radiologist. Thirty cases of clinically suspected nonunion scaphoid waist fractures with inconclusive plain radiographs were prospectively studied by means of stationary tomography and lateral flexion-extension tomography. The angle between the two scaphoid fragments as seen in extension was measured and compared with the angle as seen in flexion. A difference of 10 degrees or greater between flexion and extension was considered significant. This was noted in 14 of 15 cases of nonunion. Fifteen cases without angle differences were accurately diagnosed as stable. One false-negative case was noted, which on review was attributed to a limited extension view. Flexion-extension tomography is a highly valuable diagnostic modality in evaluating the stability and healing of scaphoid fracture and is superior to conventional (stationary) tomography.

Adolescent↗
PubMed1990

Osteochondral impaction of the femoral head associated with hip dislocation: CT study in 35 patients.

Chondral and osteochondral impactions are insults to articular cartilage and subchondral bone of the femoral head during hip dislocation. To evaluate the frequency and sites of femoral head impaction, we reviewed CT scans of 35 patients with hip dislocation (32 posterior and three anterior). Osteochondral impaction fractures were present in 20 (63%) of the 32 patients with posterior hip dislocation and in all three patients with anterior dislocation. In patients with posterior dislocation, the impaction occurred anteriorly in an arc between the 11-o'clock and 1-o'clock positions in all seven cases (100%) of right-sided dislocation and in eight (61%) of 13 cases of left-sided dislocation. Twelve (60%) of the 20 patients with femoral head impaction fracture underwent surgery; osteochondral impaction was substantiated in all 12. In those with anterior dislocation, osteochondral impaction occurred at the posterolateral aspect of the femoral head in an arc between the 4-o'clock and 5-o'clock positions. A high rate of osteochondral impaction after hip dislocation was detected in this series. Observing the site of femoral head impaction allows determination of the type of original dislocation. Alternatively, when the type of original dislocation is known, the site of femoral head impaction can be predicted.

Acetabulum↗
PubMed1988

Bony overgrowths and abnormal calcifications about the spine.

The common phenomenon of osteophyte formation about the vertebral margins and on the vertebral bodies in certain instances connotes underlying disk degeneration. The classification and mechanism of formation of these bony excrescences are not totally clear in all instances, but there is frequent association with degenerative disk change. Distorted alignment of the spinal column as in scoliosis, and functional demands on the spine, play major roles in these abnormalities. The true degree of anatomic abnormality is greater than can be appreciated on the radiographs. Syndesmophytes are vertically orientated outgrowths of trabecular bone forming in the outer margins of the annulus fibrosus and related to repeated episodes of inflammation and repair. They are classically seen in ankylosing spondylitis and colonic spondyloarthropathy. Bulky paravertebral excrescences are more likely to be found in psoriatic arthritis and Reiter's syndrome. Other bony excrescences in the spine were also discussed. OPLL is a progressive disease that can result in severe radicular and myelopathic symptoms. Although OPLL appears to have an unexplained predilection for Asians, it affects all races. Classically diagnosed on lateral radiographs of the cervical spine, it is best imaged with CT. Proper evaluation of the extent of the entire ossified mass and its effect on the spinal cord is crucial in the planning of adequate therapy.

Exostoses↗
PubMed1986

Chronic recurrent multifocal osteomyelitis.

Chronic recurrent multifocal osteomyelitis was first described in 1972 and to date 33 cases have been reported, all but one from outside the United States. This unusual osteomyelitis is characteristically recurrent and multifocal with a predilection for the metaphyses. Cultures are persistently negative and antibiotics do not appear to affect the course of the disease, which may be as long as 15 years. Females are affected twice as frequently as males and half the cases are less than ten years old. Antistreptolysin 0 titers are elevated in a quarter of the patients, and there may be a history of previous throat infection. There is an association with pustulosis palmoplantaris. We present two additional cases from the United States.

Child↗
PubMed1984

Trephine bone biopsy system: a refined needle for radiologists.

A new type of bone biopsy unit that uses standard engineering and machinery principles of self cleaning and clearance allows for greater ease and more accurate performance of biopsy. Its use consistently yields excellent biopsy material. Included is a semi-rigid K wire, which may be used with a drill, for ease of insertion and a stylet in a cannula, which allows for multiple biopsies without reinsertion. The needle is compared with standard saw tips (trephines) and sharpened cannulas.

Biopsy, Needle↗
PubMed1983

Tuberculous spondylitis. A report of six cases and a review of the literature.

Tuberculous spondylitis in the United States is a disease of decreasing incidence and, when the incidence is compared to that of developing nations, affects an older population. The thoracic and lumbar spine is most frequently involved, and in advanced disease several vertebrae may be destroyed with resulting significant morbidity and mortality. The usual clinical presentation consists of fever, back pain, and nonspecific systemic symptoms of varying duration. More advanced disease presents with neurological deficits, kyphotic deformities of the spinal column, and paravertebral cold abscesses. Treatment has changed in the past 50 years not only because of the introduction of highly effective anti-tuberculous chemotherapeutic agents, but also because of the development of new surgical approaches. Controlled studies comparing various surgical and more conservative therapeutic regimens have been conducted within the past decade. Despite these new data, controversy remains regarding the indications for surgical treatment, since anti-tuberculous chemotherapy alone is successful in a large proportion of cases. However, in situations where rapid loss of neurologic function is evident or in which progressive deterioration in spinal cord function continues in the face of apparently adequate drug therapy, it appears that anterior surgical decompression of the spinal cord is indicated to prevent irreversible neurologic deficits. Needle biopsy of bone lesions under fluoroscopic or computed tomographic control is essential in the initial evaluation of patients in order to obtain cultural confirmation of tuberculosis.

Abscess↗
PubMed1982

A protocol for selecting patients with injured extremities who need x-rays.

To help curb excessive radiography, we developed a protocol for selecting patients with injured extremities who need x-ray examination, and we tested the protocol prospectively in 848 patients to determine its safety and effectiveness. Strict adherence to the protocol would have reduced x-ray usage by 12 per cent for upper extremities and 19 per cent for lower extremities. The actual reductions were 5 per cent and 16 per cent, respectively, since further reductions were limited by patient's demands for x-ray examinations. One fracture in 287 were missed, but the treatment was appropriate and the outcome satisfactory. By eliminating superfluous x-ray procedures, the protocol could reduce charges by $79 million to $139 million nationwide, without compromising quality of care or increasing malpractice liability. Nevertheless, even the best protocol cannot eliminate all negative x-ray studies. These results should serve as a stimulus for judicious use of radiography, but also as a warning to avoid overzealous cost-containment strategies that would reduce x-ray usage to below a safe threshold.

Connecticut↗
PubMed1981

The spinous process: the forgotten appendage.

The spinous process (SP) is often neglected in the radiologic examination of the spine. Proper coning decreases scattered radiation to the SP's in the lateral view. Lateral zonography (thick cut tomography) is occasionally needed in the thoracic region. In the anteroposterior view paying attention to alignment of the SP's and the distance between them will help in the diagnosis of fracture and/or dislocation. Examination of the spinolaminal line (i.e. the line joining the base of the SP's) on the lateral view is also important in looking for the alignment of the vertebra in trauma. Local absence of indistinctiveness of the spinolaminal line may be recognized in spina bifida or when an osteolytic process involves the cortex in this area. The SP itself is involved, with or without the remainder of the vertebra, in metastatic or primary carcinoma, in trauma, rheumatoid arthritis and Paget's disease and in primary benign tumors.

Bone Cysts↗
PubMed1980

Disease states affecting both liver and bone.

The skeletal system may be profoundly affected by chronic liver disease, resulting in a variety of conditions that may include osteomalacia, osteoporosis, hypertrophic osteoarthropathy, and osteonecrosis. Additionally, many diseases, including glycogen storage disease, Gaucher's disease, and hypervitaminosis A, cause concomitant changes in both liver and bone.

Amyloidosis↗