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Biomedical subjects

H Pavlov

Publications and source records attributed to H Pavlov.

At least 73 records · Page 4Linked to original sources
PubMed1986

Neurapraxia of the cervical spinal cord with transient quadriplegia.

The purpose of this study was to define as a distinct clinical entity the syndrome of neurapraxia of the cervical spinal cord with transient quadriplegia. The sensory changes include burning pain, numbness, tingling, and loss of sensation, while the motor changes range from weakness to complete paralysis. The episodes are transient and complete recovery usually occurs in ten to fifteen minutes, although in some patients gradual resolution occurs over a period of thirty-six to forty-eight hours. Except for burning paresthesia, pain in the neck is not present at the time of injury and there is complete return of motor function and full, pain-free motion of the cervical spine. In our series, routine roentgenograms of the cervical spine were negative for fractures or dislocations in all patients. However, the roentgenographic findings did include developmental spinal stenosis in seventeen patients, congenital fusion in five patients, cervical instability in four patients, and intervertebral disc disease in six patients. Spinal stenosis was determined by two different roentgenographic methods. The first was the standard method, and the second was a ratio method devised by us. Both measurements were made at the level of the third through the sixth vertebral body on a routine lateral roentgenogram of the cervical spine that was available for twenty-four of the thirty-two patients and for a control group of forty-nine male subjects of similar age who did not have any neurological complaints. Using the ratio method, a measurement of less than 0.80 indicated significant spinal stenosis in the group of twenty-four patients for whom roentgenograms were available, as compared with a ratio of approximately 1.00 or more in the control group. There was statistically significant spinal stenosis (p less than 0.0001) in all of the patients as compared with the control subjects by both methods of determining spinal stenosis. A survey of 503 schools participating in National Collegiate Athletic Association (NCAA) football in the 1984 season found that 1.3 per 10,000 athletes had a history that was suggestive of neurapraxia of the cervical spinal cord. The phenomenon of neurapraxia of the cervical spinal cord occurs in individuals with developmental stenosis of the cervical spine, congenital fusion, cervical instability, or protrusion of an intervertebral disc in association with a decrease in the anteroposterior diameter of the spinal canal. We postulate that in athletes with diminution of the anteroposterior diameter of the spinal canal the spinal cord can, on forced hyperextension or hyperflexion, be compressed, causing transitory motor and sensory manifestations.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

The roentgenographic evaluation of anterior shoulder instability.

Retrospective evaluations of roentgenograms of 83 patients with unilateral shoulder instability were surveyed to evaluate the usefulness of various radiographic projections and to correlate the information with the osseous pathology associated with prior glenohumeral dislocation. The Hill-Sachs and the osseous Bankart defects were considered pathognomonic radiographic signs of glenohumeral joint instability. Based on history, physical examination, and examination under general anesthesia, patients were divided into three categories--(1) dislocation group, (2) subluxation group, and (3) combination group. Roentgen projections evaluated included the anteroposterior view with the humerus in internal and external rotation, axillary view, West Point view, Stryker notch, and Didiee view. The Hill-Sachs defect on the posterolateral aspect of the humeral head was best demonstrated on the combination of an internal rotation and a Stryker notch view. The osseous Bankart defect on the anteroinferior glenoid rim was best documented on the Didiee and West Point views. The external rotation and axillary view did not add significantly to the preoperative radiographic findings. In a patient with an unstable shoulder, a radiographic series that includes an internal rotation, a Stryker notch view, and either a West Point or a Didiee view would maximize the diagnostic yield per radiographic cost, time, and exposure.

Adolescent↗
PubMed1984

Measurement of anterior-posterior motion of the knee in injured patients using a biomechanical stress technique.

We performed biomechanical stress tests preoperatively on the knees of fifty-one patients with an injury to the knee. We measured the amount of anterior and posterior tibial translation at 90 degrees of knee flexion using a roentgenographic technique and a fifty-newton joint load. Knees with an isolated meniscal tear exhibited no abnormal motion. There was no difference in motion of the knee between patients with a rupture of the anterior cruciate ligament and patients with this injury who had had a prior medial meniscectomy. We found that prior knee surgery that was not associated with stability did not adversely affect the test procedure. A significant finding, however, was that only nineteen of twenty-five patients with a ruptured anterior cruciate ligament had greater excursion on the injured side compared with the uninjured knee. Because of this inconsistent result, a biomechanical stress test at 90 degrees of knee flexion measuring anterior and posterior translation under a fifty-newton joint load appears insufficient in itself to be of clinical use.

Adolescent↗
PubMed1984

Fractures of the base of the fifth metatarsal distal to the tuberosity. Classification and guidelines for non-surgical and surgical management.

Between 1973 and 1982 forty-six fractures of the base of the fifth metatarsal, distal to the tuberosity, were treated and followed for a mean of forty months (range, six to 108 months). Roentgenographic criteria were used to define three types of fractures: acute fractures characterized by a narrow fracture line and absence of intramedullary sclerosis; those with delayed union, with widening of the fracture line and evidence of intramedullary sclerosis; and those with non-union and complete obliteration of the medullary canal by sclerotic bone. Of the twenty-five acute fractures in this series, fifteen were treated with a non-weight-bearing toe-to-knee cast, and fourteen of them healed in a mean of seven weeks. Only four of the other ten, which were treated with various weight-bearing methods, progressed to union. Of the twelve patients with delayed union, one refused treatment, one was treated with a bone graft, and ten were treated initially by immobilization of the limb in a plaster cast and weight-bearing. Of these ten fractures, seven healed in a mean of 15.1 months and three eventually required grafting for non-union. Of the nine non-unions in the series, which were treated primarily with medullary curettage and bone-grafting, eight healed in a mean of three months. In all, twenty fractures were treated surgically with an autogenous corticocancellous graft that was inlaid after thorough curettage and drilling of the sclerotic bone that obliterated the intramedullary cavity. Of these twenty fractures, nineteen progressed to complete healing and one, to asymptomatic non-union.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Tarsal navicular stress fractures: radiographic evaluation.

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.

Adult↗
PubMed1983

The accuracy of double-contrast arthrographic evaluation of the anterior cruciate ligament. A retrospective review of one hundred and sixty-three knees with surgical confirmation.

In a retrospective review of 163 knees, the double-contrast arthrogram proved to be an accurate method of evaluating the anterior cruciate ligament. The status of the ligament was examined arthrographically with two stress lateral projections: a horizontal cross-table radiograph and a fluoroscopic spot radiograph. The condition of the ligament was interpreted as being normal, lax but intact, torn with intact synovial tissue, or torn or absent. The status of the ligament was subsequently determined at either arthrotomy or arthroscopy by inspection, palpation, and judgment of the degree of tension under stress. The arthrographic diagnosis was found to be 91.4 per cent accurate within the individual subclassifications and 95 per cent accurate in confirming the ligament to be either intact or abnormal. Injury to the anterior cruciate ligament frequently occurs in association with meniscal tears. In our series, 138 of the 163 knees had either a meniscal or a cruciate lesion, or both. Of these, forty-one (30 per cent) had a meniscal lesion, thirty-four (25 per cent) had a cruciate lesion, and sixty-three (45 per cent) had both. We have found the double-contrast arthrogram to be an accurate method of determining the condition of both the anterior cruciate ligament and the menisci in a single outpatient examination.

Adolescent↗
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↗
PubMed1983

Insufficiency fractures of the tibial plateau.

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.

Adult↗
PubMed1983

A posterior ascending popliteal cyst mimicking thrombophlebitis following total knee arthroplasty (TKA).

Pain and swelling of the lower extremity following total knee arthroplasty are not infrequent. The most frequent conditions responsible for these symptoms include thrombophlebitis, prosthetic loosening, infection, and fracture of either the prosthesis or the bones. In addition to these conditions, a dissecting or ruptured popliteal cyst should be considered in the differential diagnosis of acute calf pain and swelling following total knee arthroplasty. Two patients with symptoms of phlebothrombosis were evaluated retrospectively two to three years following total knee arthroplasty. In both patients the popliteal cysts dissected proximally into the thigh. A dissecting popliteal cyst is diagnosed by arthrography. The usual arthrographic films evaluated for a Baker's or popliteal cyst are anteroposterior and lateral views of the calf. These films are inadequate in patients who have undergone total knee arthroplasty; the dissecting cysts observed in the patients of the present report dissected proximally above the knee and were diagnosed on anteroposterior and lateral views of the distal femur. The more common symptoms noted after total knee arthroplasty should not be excluded due to the presence of a dissecting or ruptured cyst, as one of the patients of the present report also had a superimposed infection. Clinical considerations of a dissecting popliteal cyst are emphasized so that arthrography can be performed early in the course of the symptoms and proper treatment initiated.

Aged↗
PubMed1982

The Haglund syndrome: initial and differential diagnosis.

Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a "pump-bump." An objective method for evaluating prominence of the bursal projection is measurement using the parallel pitch lines. This measurement helps to identify patients with Haglund syndrome and patients predisposed to develop this condition, and also to differentiate local causes of posterior heel pain from systemic causes. The parallel pitch line measurement was determined in 10 symptomatic feet and 78 control feet and the results were analyzed statistically.

Achilles Tendon↗
PubMed1982

Radionuclide bone scanning in subtalar coalitions: differential considerations.

The radionuclide bone scan is a noninvasive screening procedure which can help in identifying or confirming subtalar coalitions in patients with foot and/or ankle pain of unknown origin in whom routine plain film studies are inconclusive. Five patients (seven symptomatic feet) with clinical and plain film findings suggesting a subtalar coalition are presented. The radionuclide bone scans in four patients (six feet) with documented subtalar coalitions demonstrated augmented uptake in the subtalar joint in all six feet and a secondary area of augmented concentration in the superior aspect of the talus or talonavicular joint in five feet. The radionuclide bone scan was normal in the one patient who was later proved not to have a coalition. The scans of 100 patients with foot pain of other etiologies were reviewed, and in no instance did the scan demonstrate the combination of subtalar and talus or talonavicular uptake observed in the patients with coalitions.

Adolescent↗
PubMed1982

Stress fractures of the pubic ramus. A report of twelve cases.

Twelve stress fractures of the pubic arch were seen in eleven patients who were joggers, long-distance runners, or marathoners. In two of the fractures there were complications of healing; that is, delayed union or refracture. With two exceptions, the lesions occurred in women between the ages of nineteen and forty-eight. In all of the patients the fracture was in the inferior pubic ramus near the symphysis pubis, and caused pain in the groin, buttock, or thigh. All fractures were non-displaced and easy to overlook on the initial radiographic examination; when a fracture of the pubic arch was clinically suspected but the radiographs were normal, a radionuclide bone scan was diagnostic. After identification of the fracture, running had to be curtailed until the symptoms disappeared in order for healing to occur.

Adult↗