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Biomedical subjects

G Hermann

Publications and source records attributed to G Hermann.

At least 91 records · Page 5Linked to original sources
PubMed1993

Atypical arthropathy associated with Crohn's disease.

Inflammatory bowel disease may be associated with a variety of rheumatologic abnormalities. The patterns of described enteropathic arthritis, not associated with the HLA B27 antigen, include non-deforming peripheral arthritis, bilateral, symmetric sacroiliitis, an on occasion, destructive monoarthritis. We report three patients with Crohn's disease and patterns of joint disease that have not been previously described. The patients ranged in age from 16 to 31 yr. In all cases, both joint and bowel disease were present since childhood. Antinuclear antibody, rheumatoid factor, and HLA B27 antigen determinations were negative. The distribution and pattern of joint disease were similar to that seen in rheumatoid arthritis. We propose that these cases do not represent coincident rheumatoid arthritis and Crohn's disease, but, rather, atypical manifestations of enteropathic arthritis.

Adolescent↗
PubMed1992

Case report 735. Vertebral osteosarcoma.

A case of OS of the T6 vertebra in a 58-year-old man is presented. Diagnosis was obtained by an open biopsy. The clinical and radiographic findings were described. The topic of vertebral OS was discussed at length. We emphasize the fact that OS of the spine is rare and that those cases not associated with Paget's disease or previous radiation therapy are even rarer.

Diagnosis, Differential↗
PubMed1992

Case report 711: Parosteal osteosarcoma of left femur.

We present a patient with parosteal osteosarcoma. The lesion arose at the surface of the femur without involvement of the marrow cavity. Some 24 months following resection of the involved bone, she developed distant metastases with no evidence of local recurrence. Neither the primary nor the metastatic lesions showed high-grade malignancy.

Adult↗
PubMed1992

Enzyme augmentation in moderate to life-threatening Gaucher disease.

Gaucher disease type 1 (GD type 1) is the most prevalent lysosomal storage disease and has its highest frequency in the Ashkenazi Jewish population. Deficiency of the enzyme, acid beta-glucosidase, results in the deposition of glucocerebroside primarily in macrophages. The accumulation of such "Gaucher cells" leads to visceromegaly, hepatic and bone marrow dysfunction, hypersplenism, and bony disease. Eleven GD type 1 patients, ages 4-52 y, with moderate to life-threatening manifestations, received 6-12 mo of enzyme augmentation with a macrophage-targeted acid beta-glucosidase preparation. Within 6 mo, substantial increases in Hb levels (mean = +30%) and platelet counts (mean = +39%) were observed. Hepatic and splenic volumes decreased by approximately 20% (range = 3-35%) and approximately 35% (20-52%), respectively. Hematologic and hepatic volume improvements were similar in the splenectomized (n = 4) and nonsplenectomized (n = 7) patient groups. In this patient population, no major differences were observed in the hematologic and visceral improvements with enzyme doses of 30, 50, or 60 IU/kg administered every 2 wk. Normal levels of acid beta-glucosidase activity were present in hepatic autopsy samples from one patient 11 d after enzyme infusion. In comparison, exogenous activity was absent from brain and lung specimens of the same patient. High levels (approximately 10-fold normal) were present in bone marrow samples from two patients obtained at 1 and 11 d after infusions. These studies demonstrate biochemical and clinical improvements by targeted enzyme augmentation in GD type 1, even in far advanced, life-threatening involvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses.

49 primary soft-tissue masses were studied by magnetic resonance imaging (MRI) in an effort to differentiate benign from malignant lesions. There were 24 benign and 25 malignant tumours. Images were evaluated for the presence of low-signal septation, changes in pattern of homogeneity, signal intensity, and margin definition and shape. 20 of the 25 malignant tumours (80%) demonstrated low-signal septation, and two of the 24 benign tumours (8%) also demonstrated this feature. Malignant tumours tended to change pattern from being homogeneous on T1-weighted images to being heterogeneous on T2-weighted images (72%). Benign tumours maintained their pattern on both sequences (67%). Only three of the 24 benign tumours (12.5%) changed from being homogeneous to heterogeneous. Our findings suggest that tumours which change pattern, from homogeneous on T1-weighted images to heterogeneous on T2-weighted images, and tumours which have low-signal septations are likely to be malignant. Moreover benign lesions tend to have well defined margins, and some benign masses have characteristic appearances that aid in their differentiation from malignant processes.

Adolescent↗
PubMed1992

Intramuscular myxoma: magnetic resonance features.

Magnetic resonance imaging (MRI) was performed in six cases of intramuscular myxoma of the extremities and revealed the following characteristics. All tumours were confined to muscle and had a sharply defined border. All had a signal intensity lower than skeletal muscles on T1-weighted images and brighter than fat on T2-weighted images. The signals were homogeneous on both T1- and T2-weighted images. This study did not include contrast enhancement. The diagnosis was confirmed by an open biopsy. All tumours were resected with no recurrence. Diagnosis based on these MRI characteristics was incorrect in two cases of intramuscular ganglia and in a case of intramuscular cysticercus cellulose. MRI features of intramuscular myxoma are typical in the majority of cases. Benign intramuscular lesions that contain mainly fluid can mimic intramuscular myxomas.

Adult↗
PubMed1992

Hemophilia: evaluation of musculoskeletal involvement with CT, sonography, and MR imaging.

The purpose of this essay is to illustrate features of the musculoskeletal complications of hemophilia as shown by CT, sonography, and MR imaging. MR can be used to detect early synovial and cartilaginous changes that may not be evident on conventional radiography and to differentiate between acute and chronic bleeding in soft tissues. CT is useful in evaluating subtle bony erosion and intra- and extraosseous pseudotumors. Sonography is valuable in following progression and regression of soft-tissue hematomas.

Bone Diseases↗
PubMed1992

Leukocyte scanning with 111In is superior to magnetic resonance imaging in diagnosis of clinically unsuspected osteomyelitis in diabetic foot ulcers.

OBJECTIVE: To compare the accuracies of MRI and leukocyte scanning in diagnosing clinically unsuspected osteomyelitis in diabetic foot ulcers. RESEARCH DESIGN AND METHODS: A prospective study of 16 diabetic foot ulcers in 12 patients, including both ambulatory and hospitalized patients, was performed at a university medical center. Pedal images were obtained by leukocyte scanning with [111In]oxyquinoline and MRI. Definitive diagnosis of osteomyelitis then was determined by bone biopsy for culture and histology. RESULTS: Biopsy-proven osteomyelitis was present in 7 (44%) of the 16 foot ulcers. The diagnosis was suspected clinically in 0%. Leukocyte scanning was 100% sensitive, whereas MRI was only 29% sensitive in diagnosing osteomyelitis in diabetic foot ulcers. Specificities were 67 and 78%, respectively. The positive and negative predictive values (70 and 100%, respectively) for the leukocyte scan also were greater than those of MRI (50 and 58%, respectively). CONCLUSIONS: Leukocyte scanning is superior to MRI in detecting clinically unsuspected osteomyelitis in diabetic foot ulcers.

Biopsy↗
PubMed1991

Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline.

OBJECTIVE: The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. We therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. We compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. DESIGN: Cohort study. SETTING: Institutional and private, ambulatory and hospitalized patients. PATIENTS: Consecutive sample of 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. RESULTS: As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. CONCLUSION: The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. We recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis. Diabetic patients with foot ulcers that do not expose bone should undergo leukocyte scanning, which eliminates the risk of bone biopsy in diagnosing osteomyelitis and allows for the diagnosis and treatment of this well-known but often silent precursor of lower extremity amputation.

Diabetes Mellitus, Type 2↗
PubMed1991

Fibromyxoma of bone.

We report two cases of fibromyxoma, one affecting the iliac crest and the second involving the proximal shaft of the tibia. Fibromyxoma is a rare neoplasm related to benign fibrous tumors and is characterized by exuberant, extracellular, ground substance production. Its histologic appearance is benign and distinctive and can be readily distinguished from that of myxoid chondrosarcoma or chondromyxoid fibroma. The radiographic picture is, however, difficult to interpret, and the entity can be easily mistaken for other tumors.

Adult↗
PubMed1991

Skeletal manifestations of granulocytic sarcoma (chloroma).

Skeletal manifestations of chloroma were reviewed in five patients. In four cases, a chloroma was the initial manifestation of a systemic disease. In the fifth, an elderly patient developed a bone lesion during a blastic crisis while under treatment for chronic myelogenous leukemia. Two patients presented with lytic lesions of the ribs, two with lytic lesions of the femur, and one with a predominantly sclerotic lesion of the scapula. The laboratory findings in two patients were within normal limits. All lesions were confirmed by bone biopsy.

Adult↗
PubMed1991

Case report 696: Chondroblastoma of the right acetabulum and superior pubic ramus.

A case of chondroblastoma involving the right acetabulum and superior pubic ramus in a 60-year-old man has been presented. Tissue was obtained by open biopsy. The clinical and radiographic characteristics of chondroblastoma in general, and this tumor in particular, were discussed. The histopathology and differential diagnosis were also considered. The relatively uncommon site of the tumor and its occurrence in an older patient made the radiographic diagnosis difficult, and other possibilities were discussed.

Acetabulum↗
PubMed1991

Transarticular invasion of joints by bone tumors: hypothesis.

Eight bone tumors with associated transarticular invasion of the sacroiliac joints are described. All invaded the true synovial joint and spread to the opposing bone. One tumor was benign, and the other seven were malignant. Five of the seven were primary and two were metastatic cancer. One, a myeloma, invaded the disc spaces between the fourth and fifth lumbar vertebrae and the fifth lumbar vertebra and sacrum as well as the sacroiliac joint. The right facet joints of the two vertebrae were also invaded. After a thorough search of the literature, we find that the sacroiliac joint is the most common joint to be invaded by tumors. This is followed by the vertebral disc spaces and, last, the facet joints. Apart from these joints, we were unable to find any radiographic documentation of other joints being transarticularly invaded by tumors. We noted that there is a direct relation between transarticular tumor spread and joints that lack mobility and that certain tumors, benign and malignant, tend to invade these joints.

Adult↗
PubMed1991

Role of angiography in limb-tumor surgery.

Routine preoperative angiograms obtained in 97 consecutive patients with bone and soft-tissue tumors of the extremities were retrospectively reviewed to determine the role of angiography in surgical planning. Some degree of major vessel displacement was demonstrated in 51 patients. Encasement of major vessels, which precluded limb-salvage surgery, was seen in five of 76 bone tumors and in three of 21 soft-tissue tumors. All five patients with osteochondromas had associated vessel occlusion or compromise. For surgical planning, the demonstration of adequate anastomoses in the arches of the hands and feet is important, as branches of brachial and popliteal arteries may have to be sacrificed during limb-tumor surgery. Angiographic findings indicated or supported the need for a vascular surgeon in five cases in this series. Preoperative angiography provides important information with regard to the status of the vasculature and therefore is essential in the management of bone and soft-tissue tumors of the extremities.

Adolescent↗
PubMed1991

Epiphyseal involvement in osteosarcoma.

Plain radiography and magnetic resonance (MR) imaging were used to assess the extent of transphyseal involvement in 15 consecutive patients with long bone osteosarcoma and nonfused epiphyses. The findings were correlated with those from surgical and microscopic pathologic examinations. There were no cases of false-positive findings with either MR imaging or plain radiography. Conventional radiography accurately helped predict transphyseal spread in only nine of 15 cases (60%). Spread to the epiphysis was present in 12 of the 15 cases (80%) and was accurately predicted with MR imaging in all 12 cases. This finding contradicts the common misconception that the physis acts as a "barrier" to tumor spread.

Adolescent↗