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Biomedical subjects

Murali Sundaram

Publications and source records attributed to Murali Sundaram.

At least 19 recordsLinked to original sources
PubMed2006

Quality of life, health status and clinical outcomes in Type 2 diabetes patients.

This study examines relationships between patient reported outcomes (PROs) and clinical outcomes in Type 2 diabetes mellitus (T2DM). Patients at the outpatient clinics of a university hospital completed measures of generic health status (SF-12), diabetes-specific quality of life (Audit of Diabetes Dependent Quality of Life - ADDQoL), and depressive symptoms (Center for Epidemiologic Studies Depression - CES-D). Patient reported data were merged with a retrospective collection of clinical and utilization data, including HbA1C, from electronic medical records. A Charlson comorbidity score, diabetes complications score, BMI, and total number of ER and hospital visits were calculated. Usable response rate was 44.3% (n = 385). Patients were dichotomized into glycemic control levels based on the ADA recommended A1C level < 7.0, vs. >or= 7.0. The ADDQoL, PCS-12, and MCS-12 scores were separately examined as dependent variables using hierarchical regression models, with glycemic control as the primary explanatory variable, and controlling for demographics and clinical variables including comorbidities and complications. Glycemic control was not a significant predictor in any regression model. Obesity was a significant predictor leading to poorer PCS-12 and MCS-12 scores, while depressive symptoms significantly resulted in lower PCS-12, MCS-12 and ADDQoL scores. These and other factors related to self-management behaviors may contribute to a greater understanding of how to intervene with patients with T2DM. The use of such PROs alongside biomedical measures such as A1C is recommended.

Aged↗
PubMed2006

Spondyloarthropathy presenting at a young age: case report and review.

The diagnosis of juvenile spondyloarthritis (JSA) is rarely entertained in young children who present with back and leg pain. We present a case of a 6-year-old male who presented with a 3-year history of severe back and leg pain and a positive Gower's sign, and was given a presumed diagnosis of muscular dystrophy. Presenting serologic evaluation included a mildly elevated sedimentation rate and C-reactive protein (CRP). Computed tomography of the pelvis demonstrated large erosions affecting both sacro-iliac joints. Despite the unusually young age of this patient, ankylosing spondylitis seemed the most plausible diagnosis. Following rheumatological evaluation and treatment for JSA, he showed significant clinical improvement. His disease, however, has not entirely remitted with signs of enthesitis at the Achilles tendon and knees. We present this case to illustrate that JSA could account for symptoms at an early age and not considering it could lead to multiple medical visits and diagnoses. To our knowledge, based on a search of the World literature, this would appear to be the youngest case of JSA reported with demonstrable severe sacroiliitis.

Back Pain↗
PubMed2006

Osteoblastomatosis of bone. A benign, multifocal osteoblastic lesion, distinct from osteoid osteoma and osteoblastoma, radiologically simulating a vascular tumor.

Two adult patients are described with multifocal osteolytic lesions radiologically simulating a vascular tumor. One patient had multiple bones involved. Histologically, the individual lesions had the features of the nidus of osteoid osteoma/osteoblastoma. A review of the English language medical literature yielded only one other reported case with similar features. The process is designated as osteoblastomatosis to indicate its bone-forming character, prominent osteoblast proliferation, and multiplicity. The cases are distinguished from multifocal/multicentric osteoid osteoma and osteoblastoma, and from benign and malignant vascular tumors.

Adult↗
PubMed2006

The incidence of imaging findings, and the distribution of skeletal lymphoma in a consecutive patient population seen over 5 years.

OBJECTIVE: To determine the imaging incidence, distribution, and prognosis of primary and secondary osseous lymphoma from a consecutive, single-institution patient population seen over a 5-year period. DESIGN AND PATIENTS: Of 1098 newly diagnosed consecutively seen patients with lymphoma between 1996 and 2000, 975 comprised the study group. From the electronic medical records and imaging studies, age, gender, date of diagnosis of lymphoma, bone involvement, location in bone, multifocality in bone, histopathologic type of the lesion and patient survival were recorded. Primary lymphoma of bone was defined as osseous disease with or without regional node involvement and no evidence of systemic disease for 6 months. Secondary osseous lymphoma was considered present when osseous lymphoma was associated with systemic disease or the appearance of systemic disease within 6 months of osseous disease. RESULTS: Ninety-eight patients had osseous lymphoma (10%, 95% confidence interval [CI] 8.2, 11.9). Ages ranged from 9 to 92 years (mean 54) and gender 6:4 (M:F). Ten patients (1%) had primary lymphoma of bone. Eighty-eight patients (9%) had secondary lymphoma of bone. The vertebral column was the favored site for secondary osseous lymphoma. At 5 years, there were no deaths in the primary osseous lymphoma group and a 51% mortality rate in the secondary osseous lymphoma group. CONCLUSIONS: Primary lymphoma of bone remains a rare primary malignancy, favors the appendicular skeleton, and has a significantly better 5-year prognosis than secondary lymphoma of bone.

Adolescent↗
PubMed2006

Advances in musculoskeletal tumor imaging.

In the last 2 decades, there has been a dramatic change in the clinical approach to the tumors of the musculoskeletal system. The role of medical imaging in diagnosis, staging,and eventual follow-up of patients who have musculoskeletal neoplasia has expanded. This article presents an overview of the role of imaging, recent advances in technology,and state-of-the-art techniques for evaluating musculoskeletal neoplasms. Conventional imaging modalities, ultrasound, CT, MRI, positron emission tomography, and image-guided interventions are discussed.

Bone Cysts, Aneurysmal↗
PubMed2006

Multicentric giant cell tumor of bone. Clinicopathologic analysis of thirty cases.

BACKGROUND: Giant cell tumor of bone accounts for 4% to 5% of primary bone tumors. Approximately 1% of cases present as multiple synchronous or metachronous lesions. In this study, we describe the clinicopathologic features of thirty cases of multicentric giant cell tumor. METHODS: Thirty patients who had two or more separate lesions that had been pathologically confirmed to be giant cell tumors were identified. Radiographs were reviewed to evaluate the characteristics and locations of the tumors. Histologic reexamination was performed to document morphologic features. Clinical information and follow-up data were obtained from the medical records. RESULTS: The male:female ratio was 1:2, with an average age at presentation of twenty-one years. Fifty-nine percent of the patients were younger than twenty years of age. There were ninety-four tumors in the series, with an average of three (range, two to nine) per patient. Most tumors had arisen in the long bones. Six patients had synchronous ipsilateral involvement of the distal part of the femur and the proximal part of the tibia. Radiographically, the tumors in long bones manifested as expansive lytic lesions involving the metaphysis and extending into the epiphysis. A minority of the tumors were confined to the metaphysis, had features of a fibro-osseous or bone-forming lesion, or arose in skeletally immature patients. Secondary histopathologic changes including fibrohistiocytic regions, reactive bone formation, or aneurysmal bone cyst-like changes were not uncommon. Most tumors were treated with curettage (64%) or resection (22%). The recurrence rate was similar to that of solitary giant cell tumors. Metastatic disease developed in three patients, and two patients had malignant transformation. CONCLUSIONS: Multicentric giant cell tumors occur more often in younger patients than do solitary giant cell tumors, and they frequently present as synchronous lesions around the knee. Some tumors appear as bone-forming or fibro-osseous tumors on imaging studies as a result of fibrohistiocytic regions and reactive bone formation. The risk of recurrence depends on the type of surgery that is performed. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adolescent↗
PubMed2006

Decubital ischemic fasciitis: clinical, pathologic, and MRI features of pseudosarcoma.

OBJECTIVE: The purpose of this report is to describe clinical, pathologic, and MRI findings on decubital ischemic fasciitis, which is a rare soft-tissue tumor sarcoma simulator. CONCLUSION: Decubital ischemic fasciitis is a reactive, nonneoplastic lesion typically seen in older debilitated patients at pressure points. Because this lesion simulates soft-tissue sarcoma, both clinically and histologically, it is important to recognize the MRI features and limit misdiagnosis of sarcoma.

Aged↗
PubMed2006

Calcific tendonitis of the fibular collateral ligament.

This article describes calcific tendonitis within the fibular collateral ligament, presumably from hydroxyapatite deposition, a rare cause of acute, severe lateral knee pain. Imaging findings confirmed calcifications in an intact but thickened fibular collateral ligament with adjacent soft-tissue reaction, consistent with calcific tendonitis. Magnetic resonance imaging can appear aggressive, and therefore the findings often can be mistaken for other knee abnormalities; specifically, the presentation following a twisting injury that requires avulsion fracture or ligamentous injury be excluded. Confirmation of crystal deposition with thin-section CT is helpful when suspected on MRI because it is unequivocal in depicting calcifications and bony detail.

Calcinosis↗
PubMed2006

Isolated teres minor atrophy: manifestation of quadrilateral space syndrome or traction injury to the axillary nerve?

This article prospectively determines through magnetic resonance imaging (MRI) the incidence of isolated teres minor atrophy and its gender and age distribution, and documents associated findings related to the rotator cuff, labroligamentous complex, and quadrilateral space. Two hundred seventeen consecutive shoulder MRI examinations performed over a 3-month period were prospectively reviewed and evaluated for isolated teres minor atrophy. Twelve (5.5%) patients had non-compressive isolated teres minor atrophy. Ninety-two percent (n=11) of these patients had rotator cuff or labroligamentous complex tears. No patients had an associated mass within the quadrilateral space. The average patient age was 60 years and 11 of the 12 patients were male. Isolated teres minor atrophy on MRI is most commonly seen in older patients who do not fit the expected clinical presentation of quadrilateral space syndrome. The anatomical relationship of the teres minor nerve to the joint capsule and the frequency of associated shoulder injuries in these patients raises the possibility of an association between humeral decentering and teres minor atrophy. Quadrilateral space syndrome would appear to be a very rare cause of isolated teres minor atrophy.

Adult↗
PubMed2006

Acute calcific retropharyngeal tendinitis.

Knowledge of the characteristic clinical spectrum and imaging features of this disorder are crucial for a correct diagnosis of this uncommon cause of odynophagia and dysphagia.

Adult↗
PubMed2006

Knee dislocation.

Knee dislocations are relatively uncommon. However, due to potential neurovascular complications, it is important that the diagnosis is not missed. There are two main classification systems. The position classification system, defined by the relation of the tibia to the femur, helps identify the mechanism of injury and possible associated complications. The Schenck classification system defines the dislocation based on ligamentous and associated injuries, and thus is useful for surgical planning. It is well recognized that treatment should consist of immediate closed reduction with frequent neurovascular assessment, followed by surgical repair/reconstruction. The timing and surgical technique remain controversial.

Female↗
PubMed2005

Imaging evaluation of the postoperative knee ligaments.

Until the advent of magnetic resonance imaging (MRI), evaluation of ligament reconstruction of the knee was largely based on clinical examination and radiographs. MRI is the modality of choice for noninvasive evaluation of reconstructed ligaments, menisco-capsular structures and soft tissues. This article reviews the surgical techniques, normal and abnormal appearances of the ACL and PCL grafts and common complications following ligament reconstruction.

Anterior Cruciate Ligament↗
PubMed2005

Your diagnosis? Midfoot sprain: Lisfranc ligament disruption.

Suspected midfoot sprains can be a challenge to evaluate when the initial weight-bearing views are normal. In this case, MRI allowed prompt confirmation of the suspected unstable Lisfranc ligament injury and contributed to prompt management with rigid fixation.

Adolescent↗
PubMed2005

Radiologic case study. First metarsophalangeal plantar plate injury (turf toe).

Turf toe and related injuries to the first metatarsophalangeal joint are common injuries that occur in several sports. Although often a clinical diagnosis, advanced imaging can help grade severity of sprain and evaluate for associated or unsuspected injuries. Without proper rest and conservative management, a treatable injury can have chronic sequelae and morbidity. Operative management is uncommon, but successful in returning high-level competitive athletes to their sport.

Adolescent↗