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Biomedical subjects

D Pate

Publications and source records attributed to D Pate.

At least 19 recordsLinked to original sources
PubMed1994

Videofluoroscopy in cervical spine trauma: an interinterpreter reliability study.

OBJECTIVE: The primary purpose of this study was to determine if, when confronted with a series of cervical videofluoroscopic (VF) studies, board certified radiologists who are trained in the interpretation of VF spinal examinations would be in agreement with one another with regard to the findings of normal, hypomobile or hypermobile intersegmental motion. As a secondary objective, we polled participating physicians regarding demographic issues such as time in practice, self-assessment of proficiency, the type of training received in VF interpretation and the number of VF studies read per year, in order to determine if any of these factors had any predictive value in terms of interexaminer agreement. DESIGN: Seven patients who had been exposed to cervical acceleration/deceleration (CAD) trauma from motor vehicle accidents were randomly selected from the practice of two of the authors (ACC and JSK). Three volunteers, who were asymptomatic and had no history of neck pain or injury to the neck, were also recruited. In all cases, informed consent was obtained in accordance with the Helsinki guidelines. Ten board qualified chiropractic radiologists were recruited to participate in this study. Blinded to the history and identity of the patients and volunteers, the participants were asked to view the 10 VF studies and, in each case, to report either "normal," "hypomobile" or "unable to determine" for all segments from OCC/C1 through C7/T1. The resulting data was analyzed for concordance using the kappa statistic. Kappa was calculated for all segments (OCC-T1) for agreement in "normal" vs. "abnormal" motion. The two possible choices for abnormal (i.e., hypermobility and hypomobility) were pooled together. We also compared the results of participants' responses to demographic questions with the results of their interpretations of the VF studies. SETTING: An urban group practice. Four of the patients were those of an orthopedist (ACC) and three were those of a general practitioner (JSK). PATIENT/OTHER PARTICIPANTS: Seven patients were randomly selected from a larger group of patients satisfying our selection criteria. Patients were chosen who had been exposed to CAD trauma and had been provided with at least 6 months of conservative chiropractic care, yet remained symptomatic as a result of their injuries. All had evidence of intersegmental instability in the cervical spine as defined by other investigators and none had any history of injury or pain in the cervical spine prior to their motor vehicle accident. Four males and three females with a mean age of 16 yr comprised the patient group. Two asymptomatic atraumatic volunteers were males and one was female. They were age matched to the patient group with a mean age of 38 yr. INTERVENTION: This study did not entail any form of intervention. MAIN OUTCOME MEASURES: Our primary outcome measure was that of concordance or agreement between our group of 10 participant radiologists in regard to their interpretations of the 10 VF studies provided to them, i.e., that of interinterpreter reliability. Higher values of kappa suggested that agreement between the radiologists was not likely due to chance alone. Our secondary outcome measure was a correlation between the results of our demographic questionnaires, completed by participating radiologists, and the overall interinterpreter reliability concordance. The hypothesis tested was that radiologists who have institutional training in VF, more years of experience, and those who read more VF studies annually and self-rank their proficiency as "high" are more likely to agree with others and/or are more likely to correctly analyze intersegmental motion than those whose training was less formal, and who have less experience, read fewer VF studies and self-rank their proficiency in reading VF as only "adequate" or lower. (ABSTRACT TRUNCATED)

Adolescent↗
PubMed1988

Chronic unreduced dislocations of the glenohumeral joint: imaging strategy and pathologic correlation.

Although the evaluation of acute or recurrent dislocations of the glenohumeral joint (GHJ) using routine radiography, specialized views, arthrography, and computed tomography (CT) has been extensively studied, methods of evaluation and osseous pathology of chronic unreduced GHJ dislocations are not well documented. In order to define such methods and pathology, we studied nine patients with chronic (greater than 6 months) unreduced anterior, posterior, superior, or central dislocations as well as one patient with a chronic rotator cuff injury; and seven scapular specimens, six with matching humeral specimens, with osseous abnormalities similar to those in the patients. We examined 15 additional scapular specimens with evidence of subluxation secondary to chronic rotator cuff injury. Standard, reformatted, and three-dimensional (3D) CT techniques were used to evaluate both the patients and the specimens. Our results indicate that characteristic alterations occur in the scapula and humeral head that are far more extensive than the classic Hill-Sachs, Bankart, and trough lesions. Such alterations occur at sites of osseous contact between the malpositioned humerus and scapula and are modified owing to prolonged adjustments made by the patients in an attempt to increase GHJ motion. Although routine radiography and specialized views are of some value, standard and 3D CT provide a more accurate analysis of the location and extent of the bone abnormalities and, as such, should be employed, particularly in the evaluation of patients in whom surgery is being considered.

Acute Disease↗
PubMed1988

Traction osteophytes of the lumbar spine: radiographic-pathologic correlation.

Previous reports have emphasized two types of osteophytes on the anterior aspects of the lumbar vertebral bodies: the common claw osteophyte and the less common but more significant traction osteophyte, which is indicative of spinal instability. To delineate the importance of the traction osteophyte, a radiographic-pathologic study was conducted. The results indicate that claw osteophytes are more frequent than traction osteophytes, that both may coexist in a single vertebral body, and that, in most cases, these osteophytes appear to represent different stages of the same pathologic process.

Humans↗
PubMed1988

Rheumatoid arthritis: similarity of radiographic abnormalities in men and women.

To test the hypothesis that there are significant differences in the radiographic appearance of rheumatoid arthritis between men and women, the authors blindly evaluated bilateral hand and wrist radiographs in 32 men with definite rheumatoid arthritis and 32 age- and disease duration-matched women (mean age, 56.4 years; mean disease duration, 10.5 years). Radiographically, disease distribution and severity were identical in these matched groups. Superimposed osteoarthritis was frequent in both groups and related to age. Ill-defined bone proliferation was present in 13 of 64 hands in both groups. Cystic changes and well-defined erosions were present in 12 of 64 male hands and six of 64 female hands, but this difference was not statistically significant. In women, presence of cysts and bone proliferation was related to disease duration, whereas men exhibited these atypical features independent of disease duration. There was no statistically significant difference in the frequencies of typical and atypical features of rheumatoid arthritis between the two sexes, and the authors postulate that previously reported differences relate to patient selection and lack of adequate matching.

Arthritis, Rheumatoid↗
PubMed1988

Neuroarthropathy associated with chronic alcoholism.

Neuroarthropathy involving the feet is seen most commonly in patients with diabetes mellitus. Chronic alcoholism has been implicated as a cause of neuroarthropathy, but many alcoholics have coexistent diabetes mellitus, which may not be detected by measuring blood glucose levels alone. We report five chronic alcoholic patients with neuroarthropathic alterations of the feet in whom coexistent diabetes mellitus was excluded by using laboratory methods that are more sensitive than those employed in previously reported series of alcoholic neuroarthropathy. The radiographic features of neuroarthropathy in our five cases consisted of hypertrophic changes at the tarsal joints in four, bony fragmentation at the tarsal and metatarsal regions in three, fracture dislocation at the tarsometatarsal joint in two, and multiple pathologic fractures in one. We conclude that alcoholism can result in neuroarthropathy in the absence of diabetes mellitus.

Adult↗
PubMed1987

Radiography of the hyperextended lumbar spine: an effective technique for the demonstration of discal vacuum phenomena.

A prospective evaluation of dynamic lateral lumbar spine radiographs in the erect position in 52 symptomatic patients over the age of 50 years revealed vacuum phenomena in intervertebral discs in 46%. Their frequency was greatest at the L5-S1 spinal level and decreased progressively at higher lumbar levels. Analysis of the dependency of discal vacuum phenomena on spinal position during radiography revealed that hyperextension detected all such phenomena; radiography in the neutral position detected 73% of vacuum phenomena, whereas that obtained with the spine flexed revealed 20% of vacuum phenomena. Our results indicate that lateral radiographs of the hyperextended lumbar spine are useful in the differential diagnosis of intervertebral osteochondrosis (degenerative disease of the nucleus pulposus) and infection.

Aged↗
PubMed1986

Distal interphalangeal joint involvement in rheumatoid arthritis.

Sixty-two patients with seropositive rheumatoid arthritis (RA) were evaluated radiographically for distal interphalangeal (DIP) joint involvement and were compared with 50 age- and sex-matched control subjects. The frequency of DIP erosions was 37% in the patients versus 14% in the controls; these erosions were mild and were not related to disease duration. Erosions elsewhere in the hand and wrist were of all degrees of severity and were related in part to disease duration. Osteophytes occurred frequently in both the RA group (71%) and the control group (60%). However, joint space narrowing occurred more frequently in RA patients (77%) than in the controls (46%) (P less than 0.009). The findings from this study suggest that in RA patients, DIP erosions occur frequently, do not occur in isolation, and are not simply a marker for severe global erosive disease in the hand and wrist. The high frequency of osteophytosis and joint space narrowing in both groups probably represents the overlap of osteoarthritis and RA that occurs in many patients.

Arthritis, Rheumatoid↗
PubMed1986

Perfluoroctylbromide as a contrast agent for computed tomographic imaging of septic and aseptic arthritis.

Perfluoroctylbromide (PFOB), a perfluorocarbon macrophage-labeling contrast agent, was applied to computed tomographic imaging of septic and aseptic arthritis models in rabbits. Marked enhancement of induced pyarthrosis was observed in both the knee and the sacroiliac joint. Moderate enhancement was noted in tetracycline-induced synovitis of the knee. Sterile synovitis of the sacroiliac joint and simple knee joint effusion showed no enhancement. These results suggest that PFOB is a useful contrast medium for the diagnosis of and distinction between septic and sterile arthritis.

Animals↗
PubMed1986

Bone reinforcement lines in chronic adult osteopenia: a hypothesis.

Although linear bands of increased radiodensity have been described in the tubular bones of children, similar but less often reported structures are frequent in the osteopenic skeleton of middle-aged and elderly patients. In this study, the radiology, pathology, and histology of osseous bands in the mature skeleton were analyzed in 20 cadavers, 29 macerated ancient and modern bone specimens, and 100 recent radiographs. These radiodense areas represent complete or incomplete, horizontally or obliquely oriented bars composed of compact lamellar bone. Although their precise pathogenesis is not clear, they are associated with long-standing (vs. acute) osteopenia. In some instances, bone bars appear to be formed during skeletal growth, remain hidden in the adult because of adjacent trabeculae, and are unmasked by osseous resorption. In other instances, bone bars appear to be formed initially in the mature skeleton as a response to chronic mechanical stress and, as such, are not identical with growth recovery lines observed in children. They are more accurately considered bone reinforcement lines.

Adult↗
PubMed1986

Perspective: three-dimensional imaging of the musculoskeletal system.

An evaluation of musculoskeletal disorders in 202 patients using three-dimensional CT displays has revealed the usefulness of the technique, especially in patients with fractures of skeletal areas with complex anatomy, articular disorders of the hip, and spinal stenosis. In some cases, plastic models of diseased areas have been created from the CT data and are reasonably accurate, providing a graphic representation of the disease and the ability to perform rehearsal surgery. A preliminary investigation of three-dimensional displays of MR images indicates that the technique is feasible, although its clinical practicality requires further analysis.

Fractures, Bone↗
PubMed1986

Plasma cell sclerosis of bone: a spectrum of disease.

We describe the clinical, radiographic, and pathologic manifestations of a group of disorders characterized by osteosclerosis in association with plasmacytic infiltration of bone marrow. These conditions include multiple myeloma, plasma cell granuloma, sternocostoclavicular hyperostosis, the POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes), and chronic symmetric plasma cell osteomyelitis of childhood. Although clinically unrelated in many respects, features shared by these diseases support the existence of a specific factor linking the plasma cell to local osteogenesis.

Adolescent↗
PubMed1986

Computed arthrotomography with multiplanar reformations and three-dimensional image analysis in the evaluation of the cruciate ligaments: preliminary investigation.

The normal cruciate ligaments in patient and cadaver knees were imaged with computed tomography (CT) using a graphic system that allowed reformation of the CT data in multiple planes, as well as three-dimensional display. This imaging format afforded excellent visualization of the cruciate ligaments. When the results were correlated with anatomic findings in sections of the knee from cadavers, the image data were found to be accurate.

Humans↗
PubMed1985

Scapular foramina.

Although foramina in the scapula are a rare occurrence, they produce radiolucent defects that simulate those related to skeletal metastasis or multiple myeloma. In order to define the typical location and appearance of these foramina, we initiated a radiographic and pathologic examination of macerated modern and ancient scapulae. Of 93 macerated scapulae that were examined, foramina were observed in 27 specimens (29%). These occurred at four sites: at the superior border of the bone at its junction with the coracoid process, caused by ossification of the superior transverse ligament (21 specimens); in the body of the bone inferior to the scapular spine, resulting from a disturbance in ossification during fetal development (five specimens); in the superior fossa, as a clasp-like defect (one specimen); and, at the superomedial border above the scapular spine (one specimen). The radiographic features of these foramina were compared to those produced by normal vascular channels, anatomic thinning of the bone, and skeletal metastasis or multiple myeloma. Knowledge of the typical appearance and site of scapular foramina assures accurate diagnosis.

Humans↗
PubMed1985

Atypical presentation of ankylosing spondylitis: a case study.

Ankylosing spondylitis (Marie Strumpell's disease) is a chronic inflammatory disease which principally affects the axial skeleton. The earliest radiographic sign in 90% of the patients with ankylosing spondylitis is a bilateral sacroiliitis. Up to 3% of the patients with ankylosing spondylitis will not present with the initial sacroiliitis. A case is reported of a patient with an atypical presentation. The patient's radiographic presentation consisted of syndesmophytosis without sacroiliac involvement. However, due to the patient's symptoms, radiographic appearance, and laboratory studies, the diagnosis of an atypical ankylosing spondylitis was chosen.

Diagnosis, Differential↗