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Biomedical subjects

B Ghelman

Publications and source records attributed to B Ghelman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Coexistence of cervical and lumbar disc disease.

A retrospective analysis of 200 patients requiring cervical disc surgery was performed to determine the frequency of coexistent lumbar disc or spine abnormalities. The duration of follow-up ranged from 5 to 25 years, averaging 14 years. Sixty percent were women and 40% were men, their ages ranging from 25-73 years. Antecedent motor vehicle injury had occurred in 49 cases and work injury to the spine in 23. Sixty-four percent had no history of prior back injury. It was found that over 31% had undergone lumbar disc surgery, and a high number of patients demonstrated abnormal lumbar radiographs or myelograms, including 78 with bulging discs, 100 with major root defects, 78 with minor root defects, 8 with spinal stenosis, and 7 with spondylolisthesis. Myelograms were normal in 22 cases. The sites of lumbar abnormalities included L4-5 (110), L5-S1 (90), and multilevel (8). There was a higher incidence of lumbar disc abnormalities associated with multilevel cervical spondylosis. There also was a relationship between residual symptoms and myelographic abnormalities. Two studies in the authors' institution suggest an autoimmune basis for the frequent coexistence of cervical and lumbar disc disease, namely the demonstration of antigenic properties in the nucleus pulposus and high serum immunoglobulins.

Adult↗
PubMed1990

Pneumatic sequential-compression boots compared with aspirin prophylaxis of deep-vein thrombosis after total knee arthroplasty.

This prospective, randomized study was undertaken to compare the effectiveness of pneumatic sequential-compression boots with that of aspirin in preventing deep-vein thrombosis after total knee arthroplasty. Patients were randomly assigned to one of two prophylactic regimens: compression boots or aspirin. One hundred and nineteen patients completed the study. Seventy-two patients had unilateral arthroplasty and forty-seven, one-stage bilateral arthroplasty. In the unilateral group, the incidence of deep-vein thrombosis was 22 per cent for the patients who used compression boots compared with 47 per cent for those who received aspirin (p less than 0.03). In the bilateral group, the incidence of deep-vein thrombosis was 48 per cent for the patients who used compression boots compared with 68 per cent for those who received aspirin (p less than 0.20). The results confirm the effectiveness of compression boots in the treatment of patients who have had unilateral total knee arthroplasty. Despite the use of compression boots, however, patients who had bilateral arthroplasty were at greater risk for the development of deep-vein thrombosis.

Aged↗
PubMed1989

Subacute osteomyelitis presenting as bone tumors.

The problem of the differential diagnosis between subacute osteomyelitis and primary bone tumors is a difficult one. Presenting symptoms, duration of disease, laboratory data, and location of the pathologic process are of little assistance. The authors reviewed eight typical cases. Preoperative diagnosis included benign and malignant bone tumors, as well as osteomyelitis; but the final diagnosis of osteomyelitis was made only after open biopsy and culture. The presenting symptoms and signs included: pain, usually dull; soft tissue mass; and, rarely, low grade fever. The radiographic features were usually a lytic area with various degrees of sclerotic reaction. White blood count and sedimentation rate were not helpful. The treatment, including surgical curettage and appropriate antibiotic therapy, resulted in resolution of the process and healing of the bony defects.

Adolescent↗
PubMed1989

Computed tomographic evaluation of fatty neoplasms of the extremities. A clinical, radiographic, and histologic review of cases.

Eleven lipomatous tumors of the extremities (7 liposarcomas, 4 lipomas) were evaluated radiographically by several modalities, including computed tomography (CT) in all lesions. Lipomas were seen on CT scan as well delineated, homogeneous masses with negative attenuation coefficients ranging from -95 to -160. Liposarcomas were inhomogeneous, multilobulated, poorly delineated lesions located exclusively in the subfascial or intramuscular planes, with an intermediate range of attenuation coefficients between those of fat and those of muscle. In six of seven liposarcomas, definite low density areas were identified by attenuation coefficient as fatty tissue. Magnetic resonance imaging (MRI) was obtained in two patients and was helpful in defining the extent of the tumors and their relationship to vital structures, but MRI could not differentiate benign from malignant tissue. Computed tomography is recommended as the cornerstone in the initial radiographic evaluation of growing or painful lipomatous soft tissue masses of the extremities.

Adult↗
PubMed1989

Radiology of bone tumors.

The most common and significant neoplasms of bone (benign and malignant) are presented. The radiologic appearance is discussed including the use of CT, MRI, and radioisotope scans.

Bone Neoplasms↗
PubMed1988

Evaluation of benign acetabular lesions with excision through the Ludloff approach.

Six patients with poorly defined chronic hip symptoms (length of time from initial symptoms to definitive diagnoses ranged from four months to three years) were eventually found to have benign lesions in the region of the acetabular fovea. All of these patients had seen multiple physicians including orthopedic surgeons before the definitive diagnosis was made. Four lesions were not visualized on routine roentgenographs. Various imaging modalities were necessary to demonstrate and localize these lesions. Excision through an anteromedial approach (Ludloff) in five cases required minimal dissection, operative time, and blood loss. The approach does not compromise definitive surgery (external or internal hemipelvectomy) in the unlikelihood that the lesion is found to be malignant.

Acetabulum↗
PubMed1986

Osteoid osteoma and osteoblastoma. Current concepts and recent advances.

Osteoid osteomas are common lesions, constituting one-eighth of the benign bone tumors. Their size (less than 1.5 cm) and characteristic radiographic and clinical presentation are usually diagnostic. Response to salicylates is quite variable and not a reliable sign. Extremely high levels of prostaglandin metabolites have been found in osteoid osteomas and may explain the inflammatory features of the lesions. Preoperative localization with computed tomography (CT) scans and intraoperative confirmation of location and resection with radioscintigraphy have dramatically reduced the recurrence rate in the last 26 patients. Complete excision, even if accomplished by intralesional technique, is successful in eradicating the tumor. Osteoblastomas constitute 1% of bone tumors. Although their histology differs minimally from osteoid osteomas, they achieve a larger size and behave more aggressively. Commonly occurring in the spine, they require careful anatomic delineation with CT scans and myelography. Complete excision eliminates the lesion.

Adolescent↗
PubMed1985

Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Abscess↗
PubMed1985

Meniscal tears of the knee: evaluation by high-resolution CT combined with arthrography.

The knees of 27 patients with evidence of meniscal tears were examined with high-resolution computed tomography (HRCT) immediately following double-contrast arthrography. The arthrograms and postarthrogram HRCT scans were compared for their display of anatomic and pathologic detail. The anatomy of the semilunar cartilage and surrounding structures was more clearly outlined on the HRCT scans. The HRCT scans also enabled differentiation of the menisci from the surrounding anatomic parts (popliteal tendon sleeve and popliteal cyst) and good visualization of the relationship of torn meniscal fragments. Postarthrography HRCT should be used as a complement to arthrography. With this additional information, arthroscopists can plan the most appropriate surgical treatment.

Contrast Media↗
PubMed1985

Unsuspected sacral fractures: detection by radionuclide bone scanning.

Unsuspected sacral fractures may present with confusing clinical, radiographic, and scintigraphic findings. Sacral fractures were diagnosed by radionuclide bone scans in 23 patients, most of whom were osteopenic and had only minor or no trauma. Symptoms usually consisted of low back pain, sometimes with radiculopathy, but some of the patients were asymptomatic and the fractures discovered coincidentally. Abnormalities on bone scanning consisted of increased uptake in the body of the sacrum and one or both sacral alae or only in a single sacral ala. A retrospective review showed abnormalities on radiographs in 11 of the 23 patients and in all four of the CT scans obtained, but the abnormalities were often overlooked or misinterpreted on the original reading. Bone biopsies of the sacrum, done in two patients to rule out metastatic disease, showed reactive bone formation consistent with fracture. Recognition of the characteristic scintigraphic patterns in sacral fractures and the frequency of these fractures in osteopenic patients can avoid mistaken diagnoses and unnecessary tests or treatment.

Aged↗
PubMed1984

Intracortical osteosarcoma.

A case of osteosarcoma arising in the tibia of a 15-year-old boy is reported. Of particular interest was the benign roentgenographic appearance and the confinement of the tumor within the cortex of the bone, an extremely rare phenomenon consistent with origin within the primitive mesenchyme of the Haversian canals.

Adolescent↗
PubMed1984

Deep-vein thrombosis following total knee replacement. An analysis of six hundred and thirty-eight arthroplasties.

For this study on the incidence and prevention of deep-vein thrombosis, we examined the data on 517 patients with 638 total knee replacements. All of the patients had postoperative venograms and 475 had postoperative perfusion lung scans. We collected data on known risk factors, tourniquet time, knee deformity, postoperative rehabilitation, and methods of prophylaxis, and performed extensive statistical evaluation. Forty-nine patients inadvertently did not receive prophylaxis, and in forty-one (84 per cent) of them ipsilateral deep-vein thrombosis developed. The incidence of ipsilateral thrombosis was 57 per cent in the 468 patients who did receive some form of prophylaxis. Ipsilateral thrombosis in the popliteal veins or thigh was seen in 11 per cent of the patients with unilateral total knee replacement, and contralateral thrombosis was noted in 3 per cent. Bilateral total knee replacement was associated with a 58 per cent incidence of ipsilateral deep-vein thrombosis in the calf and a 14 per cent incidence in the thigh. Pulmonary embolism was diagnosed clinically in nine patients (1.7 per cent), but was suggested on perfusion lung scans in thirty-nine patients (7 per cent). Twelve patients (2.3 per cent) received formal anticoagulant therapy. In no patient was the pulmonary embolism fatal. No specific high-risk population was identified. While no one prophylactic regimen was proved to be more effective than another in our series, we think that prophylactic measures should be part of the management of patients undergoing total knee replacement.

Adult↗
PubMed1983

Localization of osteoid osteomas--use of radionuclide scanning and autoimaging in identifying the nidus.

Surgical excision of osteoid osteomas is curative, but intraoperative localization and pathologic identification in submitted fragments may be difficult. We used preoperative technetium-99m methylene diphosphonate injection and intraoperative probing to localize the nidus of three clinically suspected cases of osteoid osteoma. Then in the pathology department, fine grain specimen x-rays and specimen autoimaging on undeveloped film were utilized. In all cases, technetium radioactivity localized within the lesion. Although the nidus was identified by fine grain specimen x-rays in only one case, the subsequent histologically proved osteoid osteoma corresponded in all cases to the fragment with the most intense autoimaging. We conclude that isotope scanning is effective in localizing osteoid osteomas at surgery, and autoimaging is effective in identifying the nidus itself by the pathologist.

Adult↗
PubMed1983

Postoperative radionuclide evaluation of osteoid osteomas.

Five cases of clinically suspected osteoid osteomas were studied by preoperative injection of technetium-99m methylene disphosphonate, intraoperative localization with a radiation-sensitive scintillation probe, and postoperative examination of the entire tissue specimen (including the presumed nidus and surrounding bone). Microradiography and light microscopy were also used. In addition, a new autoradiography technique was introduced in which the excised surgical specimen was placed on undeveloped x-ray film for pathologic localization, diagnosis of the lesions, and a study of the relative intensity of radioactive uptake in the nidus vs. surrounding bone. Autoradiography revealed that the nidus showed the greatest concentration of radioactivity, followed by the surrounding bone. The authors conclude that 99mTc can be used clinically in localizing osteoid osteomas and that preoperative and intraoperative scanning can assist in conservative surgical excision, e.g., minimal extirpation of bone in delicate areas such as the spine. For small lesions, autoradiography assists the pathologist in identifying an osteoid osteoma.

Adolescent↗
PubMed1983

Closed skeletal needle biopsy: review of 120 cases.

A review of 120 percutaneous bone biopsies performed on 110 patients in the Radiology Department of the Hospital for Special Surgery showed a 72% concurrence of biopsy findings with the patient's other clinical findings and subsequent course. Of the biopsies, 58% were correctly positive for malignancy or infection and 14% were correctly negative. The rest, 28% of the biopsies, were either incorrectly negative or had insufficient tissue for diagnosis and were therefore unsatisfactory. Only eight positive cultures from biopsy material were obtained in 21 cases with bone infections. In diagnosing metastasis, a higher success rate (84%) was noted in vertebral biopsies than other sites (66%). Poor success (44%) was noted, however, in biopsying primary bone neoplasm.

Adult↗
PubMed1983

Plica synovialis infrapatellaris: arthrographic sign of anterior cruciate ligament disruption.

The plica synovialis infrapatellaris is occasionally identified arthrographically and can be confused with an intact anterior cruciate ligament. In our series, the plica synovialis infrapatellaris was never found in association with an intact anterior cruciate ligament; proper recognition of this structure is diagnostic of a torn anterior cruciate ligament. The plica synovialis infrapatellaris can be distinguished from an intact anterior cruciate ligament primarily by its anteroinferior insertion point which is on the infrapatellar fat pad or anterior edge of the tibial plateau. In comparison, the anterior cruciate ligament is just anterior to the tibial spines. A secondary method for differentiating a plica synovialis infrapatellaris from an intact anterior cruciate ligament, the "apical angle," is also described.

Adolescent↗