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Biomedical subjects

S E Mirvis

Publications and source records attributed to S E Mirvis.

At least 91 records · Page 5Linked to original sources
PubMed1989

Titanium wire internal fixation for stabilization of injury of the cervical spine: clinical results and postoperative magnetic resonance imaging of the spinal cord.

Nine patients with dislocation of the cervical spinal with posterior ligamentous damage were treated with posterior internal fixation using a twisted pair of 22-gauge titanium wires and iliac crest bone fusion. Fixation using the titanium wire was compared with fixation using stainless steel wire for differences in surgical insertion, long term stability of bony fusion, and postoperative magnetic resonance imaging (MRI) artifacts near the implanted wire. MRI of the cervical spine is valuable for diagnosing the acute and chronic consequences of traumatic cervical spinal injury by providing anatomic evaluation of both the spinal cord and the supporting bony/ligamentous structures in the neck. Because MRI is an accurate and sensitive noninvasive test, it is especially useful for the long-term serial assessment of the region near the cervical dislocation site to detect the sequelae of spinal cord injury, including syrinx, arachnoid cyst, cord tethering, and persistent mechanical impingement on the spinal cord or spinal roots. Previous attempts at our institution to obtain useful MRI scans of the cervical region adjacent to stainless steel wires after posterior wire fixation have failed due to marked imaging artifacts from the ferromagnetic properties of these wires. Our substitution of biocompatible titanium wire (Titanium 6 A1-4V ELI alloy, Specialty Steel and Forge, Leonia, New Jersey) for stainless steel wire produced identical immediate stabilization and ultimate bony fusion of the fracture and yielded minimal MRI artifacts overlying the immediately adjacent spinal cord and neural canal; however, the installation was technically more difficult, because of the titanium wire's greater stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Protocol-driven radiologic evaluation of suspected cervical spine injury: efficacy study.

The American College of Surgery currently recommends routine performance of lateral cervical radiography of C-1 to C-7 for all patients admitted with a history of major blunt trauma. A survey of 125 North American hospitals with experience in acute trauma care revealed that 96% obtain cervical radiographs as a routine or protocol study on all patients who have suffered major blunt trauma. To ascertain the cost-benefit effect of this practice, a prospective study was conducted during a 19-month period to compare the results of admission bedside clinical assessment of the cervical spine and the outcome of cervical radiography and computed tomography (CT) performed on 408 patients admitted with a history of major blunt trauma. Among these patients, there were 138 (34%) who were judged to be mentally alert and without symptoms referable to cervical spine injury. CT was performed after cervical radiography to adequately visualize the lower cervical spine (132 patients) or to clarify uncertain radiographic findings (six patients). One nondisplaced transverse process fracture of C-7 was detected (a prevalence of less than 1% of asymptomatic patients). The combined cost of cervical radiography and CT for the 138 asymptomatic patients was $59,202. These results call into question both the cost and clinical efficacy of routine or protocol-driven cervical spine imaging for all patients who have sustained major blunt trauma and support the value of careful bedside clinical assessment of the cervical spine in mentally alert blunt-trauma victims.

Cervical Vertebrae↗
PubMed1989

Blunt hepatic trauma in adults: CT-based classification and correlation with prognosis and treatment.

To further define the computed tomographic (CT) criteria on which to guide the nonsurgical treatment of adult patients with blunt hepatic injury, the authors retrospectively reviewed abdominal CT scans obtained before surgery during a 35-month period. Blunt hepatic injury was diagnosed in 187 patients, and review revealed 37 patients in whom the liver was the site of sole or principal intraabdominal injury detected with the help of CT before surgery. A CT-based hepatic injury classification system partly derived from similar systems established with surgical assessment was devised to grade the severity of hepatic injury. CT-based injury scores ranging from grade 1 to 5 were compared with the clinical outcome in patients treated surgically and nonsurgically. Thirty-one patients (83.7%) were successfully treated without surgery, and four patients (10.8%) had findings at celiotomy that did not require further surgery. No patient who was initially treated without surgery required delayed celiotomy due to hepatic injury. The results indicate that even major hepatic injury up to and including grade 4 severity assessed with preoperative CT can usually be managed without surgery in hemodynamically stable patients.

Adult↗
PubMed1989

Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment.

Nonsurgical management of blunt splenic injury in children is a well-established method to salvage splenic function; however, nonsurgical management of adult blunt splenic trauma remains controversial. To assess the value of preoperative abdominal CT in predicting the outcome of blunt splenic injury in adults, a CT-based injury-severity score consisting of four grades was devised and applied in 39 adult patients with blunt splenic injury as the sole or predominant intraperitoneal injury detected with preoperative CT. While patients with high grades of splenic injury generally required early surgery, eight (35%) of 23 patients with initial grade 3 or 4 injury were treated successfully without surgery, and four (29%) of 15 patients with grade 1 or 2 injury initially treated nonsurgically required delayed celiotomy (n = 3) or emergency rehospitalization. Results show that while CT remains an accurate method of identifying and quantifying initial splenic injury, as well as documenting progression or healing of critical injury, CT cannot reliably help predict the outcome of blunt splenic injury in adults. Treatment choices should therefore be based on the hemodynamic status of the patient and results of serial laboratory and bedside assessments.

Adult↗
PubMed1989

The laminar space in the diagnosis of rotational flexion injuries of the cervical spine.

We measured the distance between the spinolaminar line and the articular pillars of the cervical spine (the laminar space), identified on lateral radiograph, to determine the diagnostic value of changes in this measurement in cases of unilateral facet dislocation. Twenty-seven cases of unilateral facet dislocation were compared with 70 normal spines and with 29 cases of hyperflexion injuries without unilateral facet dislocation. Abrupt alteration of the laminar space between two adjacent levels was found to be an accurate measure of rotation of the spine at the levels concerned; on the basis of this alteration, we were able to correctly diagnose 23 of 27 cases of unilateral facet dislocation and 22 of 23 cases of unilateral facet dislocation between C2 and C6. In only two of the 70 normal cases was a similar alteration of the laminar space seen, and one of these was due to a previous fracture. In none of the 29 cases of hyperflexion injury without unilateral facet dislocation was there abrupt alteration of the laminar space. We conclude that abrupt alteration of the laminar space is an accurate determinant for rotational anomalies of the cervical spine and, in particular, for unilateral facet dislocation.

Cervical Vertebrae↗
PubMed1989

Abdominal CT in the staging of small cell carcinoma of the lung.

Small cell carcinoma of the lung (SCCL) is a fulminant disease process with early extrathoracic dissemination. Surgery for cure has generally been abandoned and combined chemotherapy is the treatment of choice. The staging of SCCL is designed to identify areas of involvement for (1) comparison of therapeutic techniques, (2) prognostic determinations, (3) determination of sites of disease to use for assessment of response, and (4) for determination of areas that may require additional local therapy such as radiation or surgery. The staging evaluation, therefore, is designed to evaluate the extent of extrathoracic disease rather than just the presence of chest involvement. CT scanning has made a valuable contribution to the delineation of intrathoracic and metastatic disease and is now included in the staging workup of patients with SCCL since metastatic involvement of the liver, bone, bone marrow, CNS, and adrenal glands is common.

Abdominal Neoplasms↗
PubMed1988

Traumatic avulsion of the ureter: computed tomography correlation.

Avulsion of the ureter is a rare but significant traumatic injury, and there is often a delay in diagnosis and treatment. Radiologic signs have been described for intravenous urography but are not always present. To our knowledge, the computed tomographic appearance of avulsion of the ureter has not been described. Herein, we report the contrast-enhanced computed tomography findings in a case of traumatic avulsion of the ureter.

Adolescent↗
PubMed1988

Acute cervical spine trauma: evaluation with 1.5-T MR imaging.

Twenty-one patients with acute neurologic deficits following cervical spine trauma were evaluated with magnetic resonance (MR) imaging (n = 21), computed tomography enhanced with intrathecal contrast material (CT myelography) (n = 18), myelography (n = 13), cervical spine radiography (n = 21), and intraoperative sonography (n = 7). MR imaging proved superior to other modalities in demonstrating parenchymal spinal cord injuries and cervical intervertebral disk herniation. Although both T1- and T2-weighted studies appear necessary to evaluate the anatomic relationship of the spinal cord, thecal space, intervertebral disks, and surrounding osseous and ligamentous structures, T2-weighted sequences were more sensitive than T1-weighted studies for detection of spinal cord injury. CT myelography was superior to MR imaging in demonstrating cervical spine fractures. In most cases, myelography revealed no information that was not apparent from both CT and MR imaging studies. Preliminary experience with MR imaging of acute cervical spine trauma suggests that it should be the study of choice in symptomatic patients who are otherwise clinically stable. CT may still be required in selected patients to evaluate complex fractures.

Adolescent↗
PubMed1988

Complex fractures of the clivus: diagnosis with CT and clinical outcome in 11 patients.

During a 20-month period, fractures of the clivus occurring after craniocerebral trauma were diagnosed with computed tomography (CT) in 11 patients. Five patients had longitudinally oriented fractures; these were fatal in four patients due to either vertebral-basilar artery occlusion, brain stem trauma, or both. Six other patients had transversely oriented fractures that extended through the carotid canal and petrous temporal bone. While less frequently contributing directly to mortality, transverse fractures were also associated with cerebrospinal fluid leaks (two patients) and a cavernous sinus-carotid fistula (one patient). They were not as frequently associated with Horner syndrome or cranial nerve deficits as suggested in the current literature. This retrospective evaluation reveals two distinct injury patterns that demonstrate a difference in related morbidity and mortality.

Adolescent↗
PubMed1987

The value of retropharyngeal soft tissue measurements in trauma of the adult cervical spine. Cervical spine soft tissue measurements.

Widening of the retropharyngeal soft tissue space (RSTS) has been interpreted as a sign of cervical spine trauma. Widely differing measurements are reported in the literature. However it is clear that, using the currently acceptable limits of normal, a large number of patients without spinal injury are subjected to further tests. The RSTS on lateral cervical spine radiographs of 318 patients with a history of cervical spine trauma were measured at the C2-C4 level. The values for patients found to be normal or with fractures/dislocations were evaluated. Statistical analysis of the results demonstrates a considerable overlap in the RSTS of normal and abnormal patients. Therefore we suggest that RSTS measurements are of limited diagnostic value. Using the statistical probability of abnormality, guidelines that indicate which patients may require additional study are suggested.

Adult↗
PubMed1987

Computed tomography of Kock and modified Kock continent ileal reservoir.

Kock or modified (Javadpour) ureteroiliostomy was performed in 5 patients following cystectomy for bladder carcinoma or exstrophy. Computed tomography was utilized to demonstrate alterations in pelvic anatomy after construction of the ileal reservoirs. Detailed evaluation of the inlet and outlet antireflux arms of the continent reservoir was possible. Appreciation of the expected alterations in pelvic anatomy accompanying the Kock or modified Kock procedure will be necessary to detect postoperative complications and to achieve early recognition of recurrent carcinoma. Potential advantages of the modified Kock ileal reservoir, as developed by Javadpour, are presented.

Aged↗
PubMed1987

Tension pneumopericardium in blunt chest trauma.

Tension pneumopericardium is a rare complication of blunt chest trauma. We present two case reports of tension pneumopericardium, with clinical, hemodynamic, and radiographic evidence supporting the diagnosis. Although tension pneumopericardium is uncommon in blunt chest trauma, it should be considered in patients with pneumopericardium and hemodynamic instability.

Adolescent↗
PubMed1987

Value of chest radiography in excluding traumatic aortic rupture.

A retrospective review of chest radiographs from 205 patients with blunt chest trauma who also underwent aortography was performed. Forty-one of the 205 had aortographically proved aortic rupture. Discriminant analysis of 16 radiographic signs indicated that the most discriminating signs were loss of the aorticopulmonary window, abnormality of the aortic arch, rightward tracheal shift, and widening of the left paraspinal line without associated fracture. No single or combination of radiographic signs demonstrated sufficient sensitivity to indicate all cases of traumatic aortic rupture on plain chest radiographs without the performance of a large number of aortographically negative studies. The bedside anteroposterior "erect" view of the chest proved far more valuable than the supine view in detecting true-negative studies. Despite significant reader variability in the interpretation of the various radiographic signs, in general the analysis confirmed the role of chest radiography in this clinical situation, but suggests that its most beneficial use is in excluding the diagnosis and eliminating unwarranted aortography rather than in predicting aortic rupture.

Adolescent↗
PubMed1987

Hangman's fracture: radiologic assessment in 27 cases.

Traumatic spondylolisthesis of C-2, frequently referred to as the hangman's fracture, is typically regarded as a hyperextension injury with rare neurologic sequelae by virtue of decompression of the neural canal. The authors retrospectively evaluated their radiographic experience with this injury in 27 patients over a 24-month period. Lateral cervical spine studies and computed tomography (CT) scans (21 patients) were analyzed. CT studies provided better delineation of the fracture in all 21 patients and significant additional information in five patients (24%). Seven patients (26%) suffered initial neurologic sequelae in association with the C-2 injury. Nine patients had additional sites of fracture, including seven with associated C-1 ring disruption (26%). Extension of the fracture line into the transverse vertebral artery foramen led to vertebral artery injury and cerebellar embolization in one patient. Angiography may be necessary to detect intimal injury to the vertebral arteries when the fracture extends through the transverse foramina and to indicate the need for anticoagulation when clinically feasible.

Adolescent↗