Air-conditioned plaster casts.
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Biomedical subjects
Publications and source records attributed to G C Robin.
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Thirty-four femoral necks from human cadavers were measured by techniques assessing bone density and bone mineral density, and by the Singh index. These methods are based on photon interaction with biological components and can be applied noninvasively for clinical evaluation of changes in skeletal status. Trabecular bone volume, mineralized bone volume, and relative osteoid volume were evaluated histomorphometrically using undecalcified histologic sections obtained from the same samples. The trabecular and mineralized bone volumes showed significant correlations with the bone density and mineral density. These results enhance the validity of recently developed photon-interaction techniques for evaluating bone properties.
The authors report the case of a 15-year-old female who presented with a history of vague but constant pain about the medial aspect of her right knee. X-ray established the presence of an expanding lesion in the medial tibial plateau. Computerized axial tomography (CT) and magnetic resonance imaging (MRI) were used in the evaluation of the lesion. The authors compare the preoperative CT and MRI findings with the microscopic histopathology of the amputation specimen and note that the CT scan underestimated the extent of the microscopic tumor boundaries, whereas MRI showed altered activity beyond these boundaries.
During open reduction of thoracolumbar fracture-dislocation, the normal constraints to distraction and lengthening may be ruptured and allow instrumentation to exert deleterious traction of the spinal cord. An interspinous wire across the unstable segment together with a Harrington rod may be used to prevent potential overdistribution of the spinal cord. Thirty-six patients with fracture-dislocation of the thoracolumbar spine were treated by open reduction with Harrington rods and interspinous wiring. Of 15 patients with a partial cord lesion, four made complete recovery, and nine of the remaining 11 became ambulators. Six patients with a complete paraplegia did not improve; 15 patients remained neurologically intact following the procedure. The compressive wire and Harrington rods act in concert and enable correction of kyphosis and restoration of vertebral and discal height while protecting the cord against traction. The technique is safe and does not add to operative time.
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The relationship between osteoarthritis and osteoporosis of the hand was examined in a random sample of the Jewish population in Jerusalem. It was found that osteoporosis and osteoarthritis of the hand showed differing prevalences, only rarely coexisted, and that there was neither a positive nor a negative correlation between them (p greater than 0.05). This would strengthen the contention that these are two independent and unrelated disease processes.
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Eleven cases of osteoblastoma (spongious osteoblastoma) and four cases of osteoid osteoma (cortical osteoblastoma) involving the spine, diagnosed at Hadassah Hospital between 1970 and 1983 were analyzed. The age range was 7 to 34 years and the average clinical follow up was 63 months. The cervical spine was involved in four patients, thoracic in four, lumbar in six and the sacrum in one patient. Back or neck pain associated with stiffness was present in all cases and was often accompanied by scoliosis or torticollis. All the patients with osteoid osteoma were symptom relieved by surgery without recurrence. Seven of the patients with benign osteoblastoma presented with neurological signs or symptoms and three of these had recurrence following primary surgery. Although cortical and spongious osteoblastoma are considered as members of the same family of benign tumors of osteoblastic derivation, spongious osteoblastoma does not seem to be limited in growth potential as is cortical osteoblastoma.
Unrelenting sciatica or intermittent neurogenic claudication in the elderly may be caused by degenerative lumbar spinal stenosis. This rather common condition is produced by advanced multilevel disc degeneration leading to facet hypertrophy, infolding of ligamentum flavum, descent of the pedicles, and occasional disc herniation. The symptoms of lumbar spinal stenosis usually do not improve with time. Despite the advanced age of some patients, surgical decompression may offer significant relief. Of 19 patients who underwent lumbar decompressive laminectomy, 18 showed sufficient improvement to return to normal daily activities.
A recurrent osteoblastoma involving the acetabulum in a 27-year-old woman was found to be locally aggressive and histologically appeared to become more anaplastic with each recurrence. However, there was no evidence of distant metastases. Similar cases have been reported under such names as pseudomalignant or malignant osteoblastoma. In view of the prolonged clinical course without evidence of distal metastases, the term "aggressive osteoblastoma" seems to be more appropriate. The treatment of choice for such tumors should be further en bloc resection, avoiding the morbidity and possible mortality of the chemotherapy demanded by true malignant tumor of bone, as well as unnecessary ablative surgery.
Hydatid disease of the spine is a rare disease with a poor prognosis. Paraplegia is a severe complication and has a low chance for recovery. Surgical drainage and decompression has been the treatment of choice although success was limited. Medical treatment with mebendazole was introduced in 1977 for cystic and alveolar Hydatid disease of the liver. In this paper, a case with Hydatid disease with complete paraplegia is presented. He was treated by combined surgical and medical treatment that included several surgical drainages, decompression, and fusion procedures, accompanied by high dose mebendazole for three years. Recovery from the paraplegia was complete except for the persistence of a neurogenic bladder. Neither clinical nor laboratory evidence of activity of the disease existed after six years of follow-up. This case must encourage further clinical trials in such cases, combining surgical treatment with mebendazole.
Spondylolysis is a direct precursor of spondylolisthesis and can lead to crippling back pain. Of 1,743 patients surveyed, including 936 who were asymptomatic and 807 with back pain, 165 (including 91 who were asymptomatic and 74 with back pain) had spondylolysis, which was seen only on oblique lumbar views in 20% of cases. Because of the high false-negative rate of AP and lateral views, oblique views are essential in children and young adults. As spondylolysis is rare above L3, radiographs can be limited to L3-S1. Significantly less spondylolysis was seen in persons older than 30, with back pain usually caused by disk degeneration; thus routine oblique views could be safely omitted in older patients.
Femoral nerve neuropraxia occurred secondary to repetitive trauma at the second to third lumbar levels in a 17-year-old boy with juvenile lumbar osteochondrosis.
Scoliosis is an almost constant finding in patients with familial dysautonomia who survive their first few years. Spinal deformity is frequently progressive and can add a serious problem to the complicated disease with its already high morbidity and mortality. Because of the associated physiological disturbances, conservative treatment frequently does not control the problem and surgery by spine fusion is indicated. Our experience suggests that the operative should be performed relatively early, before the appearance of a major curvature.
The rapid development of an intraosseous ganglion following an intraarticular fracture of the distal radius in a patient suffering from familial Mediterranean fever is presented. The case supports the view that trauma may be an etiological factor in the genesis of intraosseous ganglia.
Platelet functions were investigated in 16 patients with idiopathic scoliosis (IS), in seven patients with congenital scoliosis (CS), and in 12 healthy individuals who served as a control group. All were females, aged 11 to 22 years. Platelet aggregation anomalies were observed in all IS patients. These constituted an impaired platelet-release reaction when aggregation was induced with ADP or epinephrine, but not with collagen or arachidonic acid. A decreased thromboxane A2 synthesis and impaired 14C-serotonin release were also observed when platelets were stimulated with ADP or epinephrine. Platelet from CS patients and the controls did not show any functional abnormalities when stimulated with the above four aggregating agents. The platelet function anomaly in IS patients was not associated with prolongation of the bleeding time, spontaneous occurrence of hemorrhagic episodes, or increased bleeding during invasive procedures, including major spinal surgery. The above findings and the recently described platelet structural anomalies in IS may imply that the pathological process operative in idiopathic scoliosis involves not only the axial skeleton, but also cellular blood elements. The similarity between blood platelets and muscle cells, and the anomalies that have been found in both systems in IS, support the notion that a muscle disorder may be involved in the pathogenesis of the disease.