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Biomedical subjects

E P Nance

Publications and source records attributed to E P Nance.

At least 19 recordsLinked to original sources
PubMed2000

Sequential indium-labeled leukocyte and bone scans to diagnose prosthetic joint infection.

Previous studies suggest that sequential technetium-99-hydroxymethyl diphosphonate bone scanning and indium-111 leukocyte scintigraphy may play a role during revision arthroplasty. Preoperative sequential imaging was compared with joint aspiration and clinical assessment during revision knee or hip arthroplasty. Scans were considered positive if indium-111 leukocyte uptake was incongruent or focally more intense than that of technetium-99-hydroxymethyl diphosphonate uptake. Of 166 cases, 22 were infected. Sequential technetium-99-hydroxymethyl diphosphonate and indium-111 leukocyte imaging was 64% sensitive and 78% specific. Fever, physical findings, or sedimentation rate did not identify infection reliably, and preoperative aspirate culture was only 28% sensitive. Positive scintigraphy increased the likelihood of finding infection intraoperatively from 14% to 30%, although negative scintigraphy decreased this likelihood to 7%. Based on the current study, the routine use of sequential technetium-99-hydroxymethyl diphosphonate and indium-111 leukocyte imaging cannot be advocated for differentiating occult infection from mechanical failure in painful, loose total joint arthroplasties.

Bacteriological Techniques↗
PubMed1998

Early radiographic joint space narrowing and erosion and later malalignment in rheumatoid arthritis: a longitudinal analysis.

OBJECTIVE: To analyze the time course of development of radiographic erosion, joint space narrowing, and malalignment in a longitudinal study of radiographs of the hands and wrists of 58 patients with rheumatoid arthritis (RA) taken over 18 years. METHODS: Among 210 consecutive patients in a reported cohort, 58 had at least one prior available radiograph 2-18 years earlier. A total of 141 hand and wrist radiographs in the 58 patients were scored for joint space narrowing, erosion, and malalignment in individual joints. RESULTS: Of the 58 patients studied, all developed joint space narrowing, 56 (96.5%) developed erosions, while only 24 (41.4%) developed malalignment. In radiographs of 22 patient studied within the first 5 years of disease, joint space narrowing was seen in 17 (77.3%), erosion in 16 (72.7%), and malalignment in only 3 (13.6%). Radiographic progression was seen in all 36 patients in whom the interval between radiographs was longer than 2 years. CONCLUSION: Joint space narrowing and erosion are seen in hand radiographs of most patients with RA seen in treatment centers within the first 5 years of disease. By contrast, malalignment develops in fewer patients, and generally only after 5 years of disease.

Arthritis, Rheumatoid↗
PubMed1997

Measures of activity and damage in rheumatoid arthritis: depiction of changes and prediction of mortality over five years.

OBJECTIVE: To analyze various quantitative measures of inflammatory activity and joint damage, including articular, radiographic, laboratory, questionnaire, and physical function measures, in regard to changes in status in surviving patients and prediction of mortality in non-survivors over 5 years in a cohort of patients with rheumatoid arthritis (RA) monitored in the mid-1980s and early 1990s. METHODS: A comprehensive evaluation, which included a complete joint count, radiograph, laboratory tests, physical measures of function, and self-report questionnaire scales, was performed at baseline and 5 years later in 210 consecutive patients with RA. RESULTS: Five years after baseline, 206 of the 210 patients were accounted for: 37 had died, 130 had a comprehensive repeat assessment, and 39 had a more limited repeat assessment. In surviving patients, most measures of activity were generally unchanged or somewhat better, including joint tenderness, pain on motion, and swelling; erythrocyte sedimentation rate and rheumatoid factor; as well as questionnaire scores for pain, global status, helplessness, and difficulty in performing 8 activities of daily living (ADL) according to a modified Health Assessment Questionnaire (MHAQ). By contrast, measures of damage, including joint deformity, grip strength, walk time, and radiographic scores, indicated worse status. Mortality over 5 years was predicted significantly in univariable analyses by American College of Rheumatology (formerly the American Rheumatism Association) Functional Class, limited joint motion, scores for MHAQ, global status, helplessness, grip strength, walk time, button time, and number of comorbidities and duration of diseases, as well as the sociodemographic measures of age and formal education. In multivariable Cox regressions, age, comorbidities, MHAQ, and other measures of functional status were the most effective predictors of 5-year mortality. CONCLUSION: In patients with RA, most measures of inflammatory activity were unchanged and sometimes better, while measures of damage indicated worse status in the same patients over 5 years. Measures indicating functional disability, as well as age and comorbidities, predict 5-year mortality more effectively than radiographic and laboratory data. Measures of inflammatory activity may underestimate long-term outcomes in RA, and long-term studies should include measures of damage.

Activities of Daily Living↗
PubMed1997

Comparison of 3 quantitative measures of hand radiographs in patients with rheumatoid arthritis: Steinbrocker stage, Kaye modified Sharp score, and Larsen score.

OBJECTIVE: To compare 3 quantitative hand radiograph scores, Steinbrocker stage, Larsen score, and Sharp score modified by Kaye, to one another and to other measures of clinical status in a cross sectional analysis of hand radiographs of 173 patients with rheumatoid arthritis (RA). METHODS: Radiographs were scored and compared to other measures of clinical status according to correlation and cross tabulation analyses. RESULTS: In these cross sectional studies, radiographic scores according to all 3 methods were correlated at high levels (r(s) > 0.5) with one another and duration of disease, as well as with scores for physical joint deformity and limited motion; at lower levels (0.3 < r(s) < 0.5) with physical joint swelling scores, functional status, and age; and at low levels of marginal or no clinical importance (r(s) < 0.3) with physical joint tenderness scores, laboratory data, and pain scores. CONCLUSION: The 3 scoring methods give similar quantitative information concerning hand radiographs of patients with RA. The Larsen and modified Sharp scores are preferred measures, as the detailed information facilitates comparison of different patients and monitoring of individual patients over time.

Activities of Daily Living↗
PubMed1995

Renal osteodystrophy: imaging findings that mimic those of other diseases.

Musculoskeletal complications in patients with chronic renal failure are common and may be related to the disease itself or to treatment. The altered metabolism in patients with chronic renal failure leads to renal osteodystrophy, which consists of osteomalacia and secondary hyperparathyroidism [1]. Erosive changes attributable to secondary hyperparathyroidism may be easily confused with rheumatoid arthritis, seronegative spondyloarthropathies, infection, or even malignancy. Brown tumors and amyloid deposition can easily be mistaken for a neoplastic process. The purpose of this article is to illustrate radiographic findings that are caused by renal failure and that often mimic other diseases by use of plain radiographs, CT scans, and MR images. Particular emphasis is placed on periarticular findings.

Arthritis, Rheumatoid↗
PubMed1995

Traumatic anterior dislocation of the hip: spectrum of plain film and CT findings.

Traumatic anterior dislocation of the hip represents 11% of all hip dislocations and is classified into superior and inferior types [1]. Whereas inferior anterior hip dislocation is easily recognized on an anteroposterior radiograph of the pelvis, the radiographic appearance of superior anterior hip dislocation is less straightforward, often leading to an initial misdiagnosis of posterior hip dislocation. Misdiagnosis of the direction (anterior versus posterior) of a hip dislocation can result in failed closed reduction or an improper surgical approach to open reduction. In addition, recognition of associated impaction fractures is important, as patients with this finding have a greater tendency to develop traumatic arthritis [2, 3]. This pictorial essay, which is based on our experience with 20 cases of anterior hip dislocation, including five of the rare superior type, illustrates the spectrum of radiographic findings and distinguishing features associated with anterior hip dislocation.

Adult↗
PubMed1991

Juxta-articular calcifications in secondary hyperparathyroidism: resorption after parathyroidectomy.

Soft-tissue calcification in chronic renal failure has been described, but little is understood about its pathogenesis or progression. Our patient's case is a dramatic example of complete resorption of soft-tissue juxta-articular calcification in secondary hyperparathyroidism after removal of parathyroid gland tissue. This resolution is most likely due to normalization of the calcium-phosphate ion product.

Adolescent↗
PubMed1990

Problems with the Steinbrocker staging system for radiographic assessment of the rheumatoid hand and wrist.

Hand and wrist radiographs of 202 patients with rheumatoid arthritis were graded with the classical Steinbrocker Staging System, and were also assigned quantitative scores for joint space narrowing, erosion, and malalignment according to a detailed scoring method. Steinbrocker Stage scores were correlated significantly with total detailed scores (r = 0.60 to 0.66, P less than 0.001). However, the ranges of detailed total and subtotal scores among the various Steinbrocker Stage scores were broad, with considerable overlap. Practical problems in applying the Steinbrocker staging method were identified in 26.5% of the hands graded with the Steinbrocker method. Additionally, analysis of scoring data showed discrepancies between the scoring methods in 25.2% of the hands examined; one-half of these discrepancies were felt to result from the global or overall approach of the Steinbrocker method in contrast to individual joint analysis. Asymmetry in assigned stages between right and left hands was found in 15.8% of patients. The detailed scoring method, although more time-consuming, appears superior to the Steinbrocker Stage for quantitative assessment of patient radiographic status in rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1990

Imaging of the temporomandibular joint.

Both arthrography and MR imaging are of proven value in the evaluation of internal derangements of the TMJ. Arthrography provides the advantages of a dynamic display of joint mechanics and the easy detection of disc perforation. Its disadvantages include its technical difficulty and its poor visualization of the disc in the medial-lateral plane. MR imaging of the TMJ provides excellent soft-tissue detail and more readily demonstrates medial and lateral displacements of the disc. Unfortunately, perforations of the disc or ligaments are not usually visualized, and bony detail is not seen as well as on plain radiographs or computed tomography. In addition, real-time dynamic imaging of joint mechanics is not readily available. Currently, the choice of imaging modality is based on the specific diagnostic question, and availability of arthrography and MR imaging.

Arthrography↗
PubMed1990

Cervical spine trauma.

The conventional radiographic examination remains as the single best initial study in patients with potential cervical spine injury. Computed tomography is the best, most readily available second study. Specific cervical spine injuries are presented as they follow a classification based on mechanism of injury.

Cervical Vertebrae↗
PubMed1990

Thoracic and lumbar spine trauma.

The frequency and distribution of fractures of the thoracic and lumbar spine are reviewed. Classifications of thoracolumbar spine injuries are considered. Compression or wedge fractures, burst fractures, lap seat-belt-type injuries, and fracture-dislocations are considered with discussion of findings on conventional radiography and computed tomography. The concepts of stability and instability are briefly discussed and the relative advantages of computed tomographic imaging are reviewed.

Fractures, Bone↗
PubMed1989

Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease.

Quantitative radiographic scores for joint space narrowing erosion, and malalignment in the hands and wrists of 200 patients with rheumatoid arthritis (RA) were significantly correlated with duration of disease. Nonetheless, most of the 42 patients who reported disease for less than 2 years had evidence of radiographic damage, including 35 with joint space narrowing, 28 with erosions but only one with malalignment. Significant radiographic damage in the absence of malalignment may be seen in many patients within the first 2 years after presentation of RA.

Age Factors↗
PubMed1988

Radiographic and joint count findings of the hand in rheumatoid arthritis. Related and unrelated findings.

Radiographic and physical joint count findings of the hands and wrists of 148 patients with rheumatoid arthritis (RA) were analyzed in a cross-sectional study. Quantitative radiographic scores for joint space narrowing, erosion, and malalignment were correlated highly with joint count scores for limitation of motion and deformity, and were correlated at considerably lower levels with joint swelling scores. Radiographic scores, however, were not correlated at all with joint count tenderness scores. That 2 of the most widely used indices of RA disease activity, radiographic erosion scores and joint count scores for tenderness, were independent of one another at a selected timepoint, should be considered in the design of clinical trials and long-term observation of patients with RA.

Arthritis, Rheumatoid↗