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Biomedical subjects

Y Floman

Publications and source records attributed to Y Floman.

At least 19 recordsLinked to original sources
PubMed1992

[Transoral approach to the lower clivus and upper cervical spine].

5 cases were operated via a transoral approach for basilar impression (2 cases), tumor (2), or traumatic dislocation of the odontoid process (1). In all except 1 there was compression of the lower medulla and/or upper cervical cord. Posterior cervical fusion was also performed in 2 patients. There was significant improvement in all the patients who presented with neurological deficits. Surgical morbidity was low and there was no mortality. The use of the operating microscope, microdrill, self-retaining mouth retractor, flexible oral endotracheal tube, and intraoperative fluoroscopy permit a safe, direct approach to the lower clivus and upper cervical region.

Child, Preschool↗
PubMed1991

CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures.

This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl--A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous--Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin.

Adult↗
PubMed1991

Effect of major axial skeleton trauma on preexisting lumbosacral spondylolisthesis.

The incidental occurrence of lumbar spine fractures in individuals with preexisting first degree lumbosacral isthmic spondylolisthesis may be looked upon as a simulated in vivo biomechanical experiment testing the stability of the lumbosacral subluxation. Among 200 patients with thoracolumbar spine fractures managed at the author's institution during the period of 1980-1989, five such cases were collected. All patients had a grade I isthmic spondylolisthesis at the L5-S1 level, and all sustained a burst fracture of the lumbar spine. In two patients, there was a previous history of low back pain and lumbosacral spondylolisthesis. In the other three patients, the olisthesis was judged to be old by a negative 99mTc-MDP bone scan, whereas the fractured vertebra showed intense uptake and/or by the negative operative findings at L5-S1 level during surgery. It was found that the incidence of lumbosacral spondylolisthesis in patients with thoracolumbar fractures was smaller than in the general population but the difference was not statistically significant (p = 0.213). In addition, it is concluded that mild lumbosacral spondylolisthesis can absorb considerable axial loading without an ascertainable evidence of damage.

Adult↗
PubMed1991

"Mirror image" congenital scoliosis in siblings.

Congenital scoliosis, which is caused by isolated anomalies (as opposed to multiple spinal anomalies and myelomeningocoele), is usually a nonfamilial condition. In rare instances, however, a congenital spine deformity is genetically determined. We herein report a brother and sister with a nearly identical "mirror image" congenital lumbar scoliosis. We conclude that the presence of a congenital spine deformity necessitates the screening of other siblings for a similar anomaly.

Adolescent↗
PubMed1991

Systemic mastocytosis presenting with severe spinal osteopenia and multiple compression fractures.

Systemic mastocytosis is a rare condition in which mast cells infiltrate various organs, including the skeleton. Because the mast cell secretes various bioactive substances that may induce bone resorption, this condition may cause generalized osteoporosis. We describe a case of a 28-year-old woman who presented with a painful thoracolumbar kyphosis due to generalized osteopenia and multiple pathological compression fractures and was found to have mastocytosis. She underwent operative stabilization of her kyphotic deformity with anterior interbody fusion and posterior Cotrel-Dubousset (CD) instrumentation and fusion. We conclude that mastocytosis should be suspected in an atypical case of so-called idiopathic osteoporosis.

Adult↗
PubMed1991

Transverse ligament rupture and atlanto-axial subluxation in children.

We report four children aged two to nine years with traumatic tears of the transverse ligament of the atlas and atlanto-axial subluxation. This is extremely rare in this age group since trauma usually causes a skeletal rather than a ligamentous injury. The injuries resulted from falls or motor vehicle accidents, with considerable delay in diagnosis. Flexion radiographs showed atlas-dens intervals (ADI) of 6, 7, 8 and 13 mm; all four patients were treated by posterior fusion at C1-C2 after the failure of conservative treatment. In one child with quadriparesis and a fixed ADI of 13 mm, transoral anterior resection of the odontoid was performed before the fusion. Diagnosis of this traumatic lesion requires a high level of suspicion. Conservative treatment is likely to fail; surgical stabilisation is indicated.

Atlanto-Axial Joint↗
PubMed1991

Pyogenic vertebral osteomyelitis with paralysis. Prognosis and treatment.

In the interval between 1983 and 1988, 14 patients were treated for pyogenic spondylitis complicated by neurologic compromise. There were nine males and five females aged 39-80 years. The average time between onset of symptoms and diagnosis was 2.8 months. Predisposing factors were diabetes mellitus in four patients and urinary tract infections in five patients. The infection was blood borne in all 14 patients. In two patients, the infection was superimposed on a recent vertebral fracture. The cervical spine was involved in one patient; the thoracic spine in seven; and the lumbar spine in six patients. Six patients presented with a Frankel B paralysis, six with a Frankel C paralysis, and two with grade D paralysis. The neurologic symptoms lasted between one day and six weeks before surgery. Twelve patients had anterolateral decompression. Two of the 12 patients had a second stage posterior stabilization. Two patients were deemed inoperable. All surviving patients were managed by parenteral antibiotics for three to six weeks followed by enteral route for a total of three to six months. All 12 operated patients had a significant neurologic improvement (one grade or more on the Frankel scale) with solid interbody fusion.

Adult↗
PubMed1990

Secondary prevention of low-back pain. A clinical trial.

A clinical trial, aimed at secondary prevention of low-back pain, was performed in 142 hospital employees reporting at least three annual episodes of this condition. Participants were randomly assigned to one of three groups: a calisthenics program (CAL) for 3 months with biweekly sessions of flexion exercises, a back school program (5 sessions), and a control group. The effectiveness of the two intervention programs was evaluated over a 1-year period. Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected. A monthly surveillance for the whole year showed a mean of 4.5 "painful months" in the CAL group versus 7.3 and 7.4 months in the back school and control groups, respectively (P less than 0.0001). The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength. The increased trunk flexion was associated with the rate of participation in the CAL sessions. Further research is needed to answer the question of "intensity versus type of exercise" by comparing different intervention programs, with similar intensity.

Back Pain↗
PubMed1989

[Cauda equina syndrome in lumbar disc herniation].

During the past 5 years 10 patients suffering from cauda equina syndrome as a result of prolapsed disc were treated surgically. Although considerable time had elapsed between the onset of symptoms and the operation, most of the patients improved, at least partially. The syndrome is a rare complication of a common condition of the lower spine. Awareness of its possibility and identification of the early clinical picture are essential. An accurate history and detailed physical examination are the most important factors in early diagnosis. In 5 women and 4 men, who ranged in age from 28-60 and averaged 41 years, the disks involved were L5-S1 in 6, L4-L5 in 2 and L1-T12 in 1 case. Persistent disability was found in most of the patients, including 4 with bladder and 4 with sexual dysfunction. In 7 there was residual sensory loss and in 5 some degree of motor weakness. Earlier surgical treatment seems to be the most effective method for improving the results of treatment.

Adult↗
PubMed1989

Altered structural and functional properties of myosins, from platelets of idiopathic scoliosis patients.

Platelets of patients with idiopathic scoliosis (IS) have been shown to have decreased capacity to aggregate and secrete in response to certain agonists. Similarities between the contractile protein system of platelets and muscle have made the platelets a popular model for muscle disease. We attempted to characterize the function and structure of myosin in platelets of IS patients. Blood was obtained from seven IS patients and seven matched non-scoliotic healthy controls. The mean Cobb angle measurement of the IS patients was 35.4 degrees with a mean Risser sign of 2.2. Washed platelets were isolated from the blood, and the contractile proteins from the membrane and the cytosol compartments were isolated and analyzed by two-dimensional peptide mapping. As previously reported (J Biol Chem 258:9290, 1983), peptide maps of normal platelets revealed that the heavy chain of myosin located in the platelet membrane lacks one major spot relative to the cytoplasmic myosin. In IS patients the cytoplasmic myosin lacks the same peptide that is missing in the membrane myosin of normal individuals. In addition, the ATPase specific activity of the cytoplasmic myosin from IS platelets was significantly lower compared with the activity of the cytoplasmic myosin from normal platelets. These results suggest the presence of a fundamental abnormality of IS platelet contractile proteins.

Adenosine Triphosphatases↗
PubMed1989

Dural penetration by interspinous process segmental spine instrumentation: case report.

A case of pseudo-meningocele complicating posterior spine fusion with interspinous process segmental spinal instrumentation is presented. The L rod rotated postoperatively 90 degrees and penetrated the dura. The presenting symptoms were pain accompanied by fixed lumbar and hip flexion contractures that improved dramatically after removal of the penetrating part. The unusual course as well as the treatment and recommendation for prevention are discussed.

Adolescent↗
PubMed1989

Isthmic spondylolisthesis in pycnodysostosis.

Pycnodysostosis is an inborn skeletal syndrome manifested by short stature with a concomitant spinal deformity and by dense sclerotic fragile bones. We report a 35-year-old woman with pycnodysostosis and isthmic spondylolisthesis. Pycnodysostosis should be added to the differential diagnosis of spondylolisthesis.

Adult↗
PubMed1989

Functional, biochemical, and structural anomalies in platelets of patients with idiopathic scoliosis.

Idiopathic scoliosis (IS) is the most common type of lateral curvature of the spine, the etiology of which is unknown. Among the various pathological changes that have been reported in IS are platelet anomalies. Since the platelets are not involved mechanically in the spinal deformity, platelet disorders may reflect a basic cellular pathology and not a secondary change attributed to the spinal curvature. In the present review, a summary of the platelet anomalies in idiopathic scoliosis is presented. The accumulated data indicate the existence of profound functional anomalies in platelets of patients with IS. An attempt is made to clarify the different anomalies and to try to link them together.

Blood Platelets↗
PubMed1987

Disseminated intravascular coagulopathy in patients with cancer undergoing operation for pathological fractures of the hip.

Disseminated intravascular coagulopathy is a serious complication of numerous pathological conditions, particularly metastatic cancer. It is rarely encountered in orthopaedic surgery. Prompt recognition and treatment is required to prevent death. We describe two patients with pathological fractures of the proximal femur due to metastatic disease who died from disseminated intravascular coagulation after operation. A high index of suspicion, careful monitoring of the clotting mechanism and prompt treatment are required.

Aged↗
PubMed1987

Cord compression as the presenting symptom of extradural malignant lymphoma.

Six patients with spinal cord compression as the presenting symptom of malignant lymphoma are described. These patients suffered from back pain for several months and were diagnosed after sudden paraparesis appeared. Five patients were treated by operative decompression followed by local irradiation, and all regained their motor function. A sixth patient presented with a more insidious paraparesis. A bone marrow aspiration established the diagnosis of malignant lymphoma, and this patient recovered with radiation and steroids alone. Thus, we recommend considering malignant lymphoma as a possible cause of acute cord compression, attempting to establish the diagnosis on an emergency basis within several hours, and attempting to achieve decompression with local radiotherapy and intravenous dexamethasone.

Adult↗
PubMed1987

Low-back pain in pregnancy.

Two hundred women were interviewed within 24-36 hours after giving birth. The patients were not examined. It was found that 56% of the patients suffered from low-back pain during pregnancy. The percentage of Caucasians was statistically higher in the back pain group. The percentage of Hispanics was statistically higher in the no pain group. Among the variables that were compared in both groups were the age, the weight gained by the mothers during pregnancy, the baby's weight, the number of previous pregnancies, number of prior children. None of the variables reached a statistically significant level. The pain group complained of pain the low-back area, which radiated in 45.5% of cases to the lower extremities. In about one-third of the patients the pain increased as the day wore on, whereas in another one-third the pain increased during the night and disturbed sleep. Standing, sitting, forward bending, lifting, and walking tended to increase the pain. Most of the patients started suffering from back pain between the fifth and seventh months of pregnancy. Several theories to explain the occurrence of backache during pregnancy are discussed.

Back Pain↗
PubMed1987

Spondylolysis in the upper lumbar spine. A study of 32 patients.

Reports of spondylolysis in vertebrae other than those of the lower lumbar spine are rare. We report 32 patients with upper lumbar spondylolysis who have been studied clinically, radiologically and scintigraphically. Twenty patients had bilateral lesions, and seven of those with unilateral lesions had structural changes or anomalies in the opposite posterior arch. Positive scans were found to be associated with a short clinical history, and indicated stress-related lesions. Our findings suggest that mechanical factors may play a role in the aetiology of spondylolysis in the upper lumbar spine similar to that which they play in the lower lumbar spine, and that local structural anomalies may contribute to abnormal loading of these vertebrae.

Adolescent↗