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S W Dihlmann

Publications and source records attributed to S W Dihlmann.

17 recordsLinked to original sources
PubMed1997

Acquired hyperostosis syndrome--AHYS--(sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, SAPHO-syndrome): bone scintigraphy of the anterior chest wall.

The objective of this report is to provide a description of diagnostically significant scintigraphically recognizable sites and patterns of acquired hyperostosis syndrome (AHYS) on the anterior chest wall (ACW), which is involved in 82% of AHYS patients. In 49/90 of our own AHYS patients, planar bone scans of the ACW were performed with the gamma camera, applying an average of 650 MBq of 99mTc-phosphate complexes. In addition, 53 atraumatic patients with extrathoracic cancer were available for routine whole-body scintigraphy. None of these patients had increased uptake identifiable as metastasis clinically or by imaging modalities in either the ACW or the rest of the skeleton. The scintigraphic involvement of the various morphological ACW structures is described in AHYS. Moreover, attention is called to the diagnostic significance of focal hyperactivities at the anterior end of the 2nd-8th rib of adults, which are in the 5th place with respect to their frequency in AHYS. The diagnostic significance of sternocostal-joint involvement in AHYS can likewise be recognized by bone-scan scintigraphy and will be discussed. Bone scintigraphy is more sensitive than radiomorphological imaging in AHYS. This, however, only applies under three conditions. 1. The increased radiotracer uptake in the upper sternocostoclavicular region must be assessed on both the anterior and the posterior view of the ACW scan. 2. In addition to the anterior view of the routine scintiscan, further anterior scans with reduced scan time of the gamma camera are usually necessary. This ensures better visibility of the involvement of certain morphological structures that are important for AHYS diagnosis. Moreover, a statement can be made about the inflammatory ossifying activity/inactivity of the AHYS on ACW.3. Increased radionuclide uptake in the manubrium sterni and corpus sterni on the anterior scan should be verified by additional lateral or oblique scans of the thorax (sternum).

Acne Vulgaris↗
PubMed1996

Endoscopic discectomy in pediatric and juvenile lumbar disc herniations.

Most herniated lumbar discs in children and adolescents respond to conservative treatment, but some young patients with persistent low back and neurological symptoms do not respond to noninvasive treatment and require operative treatment. Because the long-term results of disc surgery depend not only on the disc disease itself but also on the degree of surgical trauma, disc herniations in children and adolescents should be treated with minimally invasive procedures. We report our experience with four young patients aged 8-17 years with contained or small noncontained lumbar disc herniations who were treated by percutaneous endoscopic discectomy (PED). The clinical results were good to excellent in all four cases, with follow-up of 1 to 5 years. There were no complications, and the operation was tolerated well by the young patients. We recommend percutaneous endoscopic lumbar discectomy in patients with contained or small uncontained disc herniations who do not respond to conservative treatment.

Adolescent↗
PubMed1995

The "mirror image" and "two-thirds" types of hemispherical spondylosclerosis.

Clinical and radiological examination of 167 hemispherical spondylosclerosis (HSS) patients (56 male, 111 female) revealed a total of 186 cases of HSS with multiple incidences occurring in 18 patients. Radiologically these HSS cases were characterized by erosion and new bone formation at the inferior and upper end plate of the vertebra below, periosteal bone apposition or ossification of the anterior longitudinal ligament, spondylophytes, and signs of degenerative alteration of the vertebra and disc. In addition, the size and location (anterior, middle, posterior third) of each HSS in the lateral view was investigated. The cases were also investigated for reflection phenomenon between supra- and infradiscal sclerosis and for kyphotic angulation of the two adjacent vertebrae. The results showed that in 105 cases (56.5%) the HSS filled out the entire vertebral area; 97 cases (52.2%) showed a mirror-image type HSS; while in 8 cases (4.3%), the infradiscal sclerosis was polymorphic. In 81 cases (43.5%), the sclerosis was limited to the anterior two-thirds; this is termed "two-thirds" type. All 81 of these cases of HSS showed a kyphotic angulation of at least 4 degrees. Of these, 61 (32.8% of the total) showed reflection phenomenon while 20 (10.7% of the total) had polymorphic infradiscal sclerosis. Overall, 158 cases of HSS (85%) exhibited the reflection phenomenon between supra- and infradiscal sclerosis, whereas 28 cases (15%) revealed polymorphic sclerosis of the subadjacent vertebra. Kyphotic angulation was completely absent when HSS was visible in the entire vertebra. A dorsal gap of the disc space was seen in 36 cases (19.4%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[MR tomography in autologous plastic repair of the anterior cruciate ligament: a comparison of 2 surgical methods].

UNLABELLED: The aim of this prospective MRI study was the analysis of the post-operative signals derived from two techniques for cruciate ligament reconstruction. PATIENTS AND METHODS: Group 1 consisted of 15 patients who had undergone conventional plastic repair by patellar tendon transplant and group 2 was made up of 15 patients with arthroscopic reconstruction with semitendinosus grafts. They were examined at 6 weeks and 6 months post-operatively. RESULTS: Typical appearances of normal transplants were found in 19 patients. After 6 months 8 of the patellar tendon transplants and three of the semitendinosus transplants could not be clearly defined. At this time there was a significant increase in signal intensity in the middle third of the transplant in group 1. CONCLUSION: Bearing in mind the different operative techniques, there was a higher impingement rate in group 1. The post-operative MRI findings at 6 months after surgery allowed differentiation between pathological changes (impingement) and revascularisation (remodelling).

Adolescent↗
PubMed1995

[Spondylitis: borderline findings in magnetic resonance tomography].

MR studies of 41 patients with confirmed spondylitis were evaluated with regard to imaging findings resembling metastases or fracture. 30 patients had MR results considered typical for spondylitis (contiguous changes in two vertebrae and disc, soft tissue tumour). 11 patients had MR studies differing from this pattern. Absence of soft tissue involvement and discontinuous marrow changes may be misdiagnosed as bone marrow metastases.

Adult↗
PubMed1994

[Whiplash injury of the cervical spine--on the role of pre-existing degenerative diseases].

Radiological investigations contribute little in differentiating the problems of patients with whiplash injuries. Nevertheless the more prolonged cases of whiplash injuries must not be attributed to preexisting degenerative disease, despite radiologically-proven medicolegal opinion. In this study, 60 patients who were seen for whiplash injuries in the Department for Trauma and Reconstructive Surgery at the University Hospital Hamburg-Eppendorf for clinical and radiological evaluation, an average of 5.7 years post injury, were divided into two groups (n = 30) depending on radiologically-proven preexisting degenerative changes of the cervical spine. On average the patients with degenerative changes were 11.2 years older than those with healthy vertebral columns and also demonstrated an increase in acute symptoms in the lower cervical spine (cervicobrachial syndrome). The chronicity of individual symptoms such as neck-pain, dizziness, nausea and psychological illness was also observed in both groups. Problems such as paresthesias as well as pain in the shoulder-arm-area appeared to increase in subsequent check-ups, irrespective of the earlier degenerative changes. Patients with typical posterior headaches recovered faster when they had radiologically normal spines. Presenting late, there was a significant accumulation of patients with pre-existing degenerative changes complaining merely of tinnitus. The earlier changes in any individual motion segment do not determine the clinical course of whiplash injuries, but merely represent an area of increased vulnerability to trauma. On the other hand, trauma has not been proven to influence the development or aggravation of degenerative changes in normal or diseased spines. We are not able to differentiate the posttraumatic course from the natural history of the degenerative process, either clinically or radiologically. Considering the involvement of sensitive neurological structures the classical objective organic diagnosis of "whiplash injury" may not be adequate in describing the complaints of patients, and should not be used to justify the rejection of the patients subjective symptoms as mere simulation for financial gains. The evaluation of the patients' X-rays using Arlen's technique sheds no further light on the issue.

Accidents, Traffic↗
PubMed1992

[Fat pad signs and supinator fat line in cubital trauma].

The fat pad sign and the supinator fat line (SFL) are valuable diagnostic aids in the evaluation of bony cubital injuries. A total of 377 lateral X-rays of the elbow joint-including 121 fractures--were investigated. The supinator fat line exhibited bar-like and bird-like configurations in 55.9% and 41.8% of healthy test subjects, respectively. In the presence of a fracture, a wavy configuration, directed downwards from, or running parallel to, the upper edge of the radius, was seen in 95% of the cases. If in the event of an injury to the elbow a wavy configuration is seen in association with a positive anterior and/or posterior fat pad sign, bony involvement of the joint-forming elements may justifiably be suspected.

Adipose Tissue↗
PubMed1992

[Fracture lines of the foot].

In follow-up examinations of 112 patients who had been diagnosed as having a sprained foot, bony lesions, confirmed by X-ray films, were found in 96 (85.7%) patients. Up to this time the fractures had not been found in 58 of them. The fractures were found to be distributed in a point-specific location, i.e., a precisely defined anatomical area in 43 cases (44.8%) and a linear presentation in 53 (55.2%). This linear grouping of bony injuries is seen to develop along the path of joints, bones and ligamental insertions that anatomically follow one another in a functional manner. The line-like pattern to these presentation permitted us to develop 3 line sets that could be attributed to specific mechanisms of injury. The lateral line (56.6%) specially follows a supination sprain to the foot. The medial line (20.8%) is seen to follow injuries that involved a blow along the longitudinal axis. The transverse line (22.6%) follows trauma involving the Chopart joint. Six diagrams are presented to illustrate the mechanisms of foot trauma, with their vectors of force and the corresponding injuries that may result. Radiological examples of several clinical cases are given to demonstrate these three fracture lines.

Adolescent↗
PubMed1991

Acquired hyperostosis syndrome: spectrum of manifestations at the sternocostoclavicular region. Radiologic evaluation of 34 cases.

Thirty-four patients with chest wall hyperostosis, a condition which has been designated by various terms in the literature were evaluated radiologically. We prefer the name acquired hyperostosis syndrome (AHS), which we categorize into the complete, incomplete and possible form. In complete AHS, sternocostoclavicular hyperostosis is associated with axial and/or peripheral (endosteal, periosteal, enthesopathic, metaplastic) hyperostosis and with psoriasiform or acneform dermatosis. In addition, these three manifestations are accompanied by erosive or non-erosive peripheral and/or axial arthritis to a variable degree. Sometimes, concomitant findings which are consistent with ankylosing spondylitis are also to be found in the axial skeleton. AHS is manifested at 11 different sites on the anterior chest wall. Ossification forms of the costal cartilage, inflammatory enthesopathies (three different insertions) and focal hyperostoses as well as processes of remodelling of the ribs, clavicles and sternum which are described in detail have particular diagnostic significance. AHS can start simultaneously at one, two or several sites on the anterior chest wall. Conventional tomography (possibly supplemented by CT) is necessary for early diagnosis and for analysis of the various findings on the anterior chest wall.

Adult↗
PubMed1991

[The supinator fat line--its visualization and validity].

Based on 259 lateral x-ray films of the elbows of healthy subjects, the typical forms of the fat plane overlying the supinator muscle were determined. The forms of this plane in 121 patients who had suffered bony lesions in the elbow joint region were juxtaposed to these x-ray images. Measurements of the proximal distance between the fat plane and the extended tangent of the anterior humeral cortex layer revealed that distances of more than 13 mm in children and of more than 18 mm in adults are highly suspicious of a fracture. The good visualisation of the fat plane by means of various imaging methods is appropriately demonstrated.

Adipose Tissue↗
PubMed1991

[Alloarthroplasty of the hip joint. Radiologic diagnosis of loosening and infection in cemented total endoprostheses].

Patients with problems following implantation of cemented total hip prostheses must be clinically examined. This examination is followed by a series of diagnostic imaging procedures. These include X-ray diagnosis, 3-phase 99mTc-MDP bone scans, scintigraphy for inflammation, and arthrography, performed singly or as sequential studies. X-ray findings and scintigraphic patterns arousing or confirming a suspicion of aseptic (mechanical) or septic (infectious) loosening of the prosthesis are evaluated and discussed.

Hip Prosthesis↗
PubMed1990

[Supercilium acetabuli. A stress indicator of the hip joint cartilage].

A thousand radiographs of the hip joints in adults were evaluated quantitatively and the following statistical conclusions were drawn: the normal forms of the supercilium acetabuli are either parallel or convex. Wedge-shaped supercilia indicate increased stress on the cartilage only in cases with hip dysplasia. A supercilium of more than 4mm raises the suspicion of increased stress on the cartilage. Normally, the joint space as shown on a radiograph does not fall short of 3mm. Eight formulas have been defined which can be used after planimetry of the supercilium and the articular surface in order to indicate increased stress on the cartilage and a risk of developing an arthrosis of the hip. These formulae are of practical value if the radiographs appear normal to visual inspection.

Acetabulum↗
PubMedDate not supplied

[Analysis of migration of screwed acetabular components following revision arthroplasty of the hip joint. Results of single-image roentgen analysis].

Out of 57 revised acetabular components, which were regularly checked, 47 had been replaced by a cemented Müller's acetabular reinforcement ring resp. a cementless Müller's Sl-shell with flange. Both types of cups are anchored in the acetabular roof with cancellous bone screws (tab. 1). 42 cases with radiograph series permitted a detailed analysis with the EBRA-method, a computer aided method for the evaluation of acetabular spatial migration based on standard radiographs of the pelvis. The clinical results were very satisfying (tab. 6). The screwed acetabular components migrated little, although, some essential displacements of the center of rotation (in relation to the anatomical position) had to be accepted. As was recognizable with today's inaccurate methods of measuring the center of the head, the displacement too far towards cranial influenced the migration tendency less than an excessive lateralisation. Especially satisfying is the fact, that no increased migration was observed after reconstruction bone grafting of severe acetabular defects, provided that at least a partly direct contact between the acetabular component and the original bone stock was obtained. For the first time EBRA shall be introduced here as a method which shows the migration and the spatial inclination of the acetabular cup in a vector chart.

Acetabulum↗
PubMedDate not supplied

The supercilium acetabuli score: an additional criterion for estimating the biomechanics of the hip joint.

There are significant correlations between the surface of the acetabular roof sclerosis (supercilium acetabuli) in the hip joint on a normal a.p. radiograph and the corresponding surface of cartilage. This correlation can be defined through mathematical formulas and scaled afterwards. These scales are determined on the basis of our clinical experience with the new supercilium acetabuli score. The score is related to the biomechanical situation of the hip joint and describes 3 classes: Class I = optimum, class II = balance, class III = imbalanced correlation between the supercilium acetabuli and the corresponding part of the joint space. For simple measurement of both surfaces, we developed a measuring instrument, the superciliometer, with which it is possible to obtain standardized conclusions describing the functional morphology of the cartilage in the pressure distribution zone of the hip joint, irrespective of whether there are already any visible radiological signs of coxarthrosis or not.

Acetabulum↗
PubMedDate not supplied

Indications, results and complications in connection with free vascularized bone transplants for extremity preservation.

A report is presented on 5 years experience with 33 cases of free vascularized bone transplants for extremity preservation. The indications, results and complications will be demonstrated. The successful results so far were achieved not only by careful indications but by virtue of a strict postoperative treatment scheme extending from direct postoperative blood-flow monitoring through the raising of a skin flap and angiographic control of anastomosis patency to immobilisation/mobilisation and orthotic management.

Adult↗
PubMedDate not supplied

[Lumbar epidural lipomatosis].

Spinal epidural lipomatosis is a pathological accommodation of fat tissue in the spinal canal. It seems to be a disease entity, which, though rare, has recently been diagnosed more frequently and can be accompanied by neurological deficits. The thoracic spinal canal is the preferred localization. Eighteen cases of symptomatic lumbar epidural lipomatosis have been described in the literature. We are reporting on our experience with another 8 patients. Three of these patients presented with the typical signs of spinal nerve irritation. In these cases epidural lipomatosis was associated with a small disk herniation without direct contact to the spinal nerve. Another 5 patients showed the clinical picture of a spinal claudication. In all 5 patients, there was a concentric compression of the thecal sac by epidural fat. In one patient, the cause of the lipomatosis was assumed to be long-term steroid therapy following kidney transplantation. Four patients suffered from extreme obesity. No cause for lipomatosis could be found in 3 patients. A microdiskektomy was performed in the 3 patients with the associated disk herniation; the remaining patients were treated conservatively. In 6/8 patients (3x surgery/3x diet), an "excellent" or "good" clinical result could be achieved after 1 year. Two patients had a "satisfactory" result. Lumbar epidural lipomatosis can be treated conservatively in cases with only mild neurological dysfunctions and known cause (e.g. obesity, steroid therapy). The surgical removal of associated disk herniation proved to be sufficient in cases described in this paper.

Adult↗