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Biomedical subjects

J A Epstein

Publications and source records attributed to J A Epstein.

At least 109 records · Page 6Linked to original sources
PubMed1983

Degenerative spondylolisthesis with an intact neural arch: a review of 60 cases with an analysis of clinical findings and the development of surgical management.

The treatment over the past 12 years of 60 patients with degenerative spondylolisthesis with an intact neural arch is reviewed. The patients averaged 65 years of age, with women outnumbering men by a ratio of 2:1. Symptoms in the lower extremities had been present for 3 months to 10 years, although varying back pain had existed for longer periods. Two-thirds showed signs of motor dysfunction. Sensory alterations and a positive Las ègue's sign could be demonstrated in only one-half of the patients studied. Four of 5 patients developed intermittent neurogenic claudication, with varying evidence of painful radiculopathy. The marked disability caused by claudication contrasted sharply with the lesser neurological changes, and these patients required early surgical decompression. Diagnostic studies included electromyography, plain x-ray films, tomography, computed tomographic scanning, and myelography. The latter outlined a relative stenosis caused by olisthesis as well as arthrotic and spondylotic changes that determined the extent of decompressive operation required. The L-4, L-5 interspace was involved in 56 patients, L-3, L-4 was involved in 2, and L-5, S-1 was involved in 2. The ideal operation with L-4, L-5 olisthesis included complete laminectomy of L-4 and L-5 with unroofing of the lateral recesses and foraminotomy. This more extensive procedure was justified because of the failures encountered in previous patients in whom inadequate decompression had been performed. Among failures, obesity, diabetes, hyperlordosis, and extensive long-standing dysfunction were prominent. The relief of symptoms of intermittent neurogenic claudication was the most gratifying response observed. There was no unusual morbidity.

Adult↗
PubMed1982

Isolated follicle-stimulating hormone deficiency in a woman with X chromosomal mosaicism.

Primary amenorrhea was observed in a 40-year-old woman with a proportionate female habitus. Serum levels of luteinizing hormone (LH) (71 to 97 mIU/ml) and estradiol (less than 10 pg/ml) were in the postmenopausal range, while follicle-stimulating hormone (FSH) remained at the lower limit of detection (1 to 6 mIU/ml). LH was found to be biologically active in a mouse Leydig cell testosterone production assay. Chromosomal analysis revealed three major cell lines: 5% 45,X; 83% 46,XX; and 3% 47,XXX. The remaining cells showed apparently random aneuploidy and chromosome rearrangements. Intravenous administration of 150 micrograms of gonadotropin-releasing hormone produced a threefold elevation in LH but did not alter FSH levels. Review of ovarian biopsies performed at age 22 revealed a multitude of primordial follicles and one follicle with antrum formation. There was no evidence of recent or past ovulation. An insulin tolerance test evoked normal responses in serum growth hormone, prolactin, and cortisol. This is the first reported case of an isolated deficiency of FSH associated with mosaicism of the X chromosome. This coexistence of functional and genetic aberrations suggests that the differential secretion of LH and FSH may be related to specific independent loci on the X chromosome.

Adult↗
PubMed1982

A comparative study of the treatment of cervical spondylotic myeloradiculopathy. Experience with 50 cases treated by means of extensive laminectomy, foraminotomy, and excision of osteophytes during the past 10 years.

This paper reviews management by means of the posterior approach of 50 patients with cervical myeloradiculopathy caused by spondylosis and stenosis of the spinal canal seen in the past 10 years. Careful selection of patients is an absolute necessity since a primary cause of failure occurred in individuals who subsequently proved to have motor neurone disease. Older individuals with long-standing neurological deficits, especially long tract signs indicative of fixed lesions, were benefited primarily by a lack of further progression of their disorder and occasional improvement in hand function and gait. Diagnostic evaluation should include electromyography, nerve conduction studies, and sensory evoked cortical potentials. With the introduction of the fourth generation CAT scanning equipment, additional diagnostic information is available regarding the internal configuration of the spinal canal, its contents, and the amount of available space at various levels. Supplementary myelography remains of basic importance. Laminectomy includes two levels above and below the areas of significant canal encroachment. Foraminal decompression with removal of only the innermost third of the foramen permits mobilization of the nerve roots, removal of osteophytes and untethering of the dural sac. A great deal of importance is attached to the preservation of the cervical lordotic curve since, with an adequate decompression and an intact dura, the cord moves dorsally into an expanded canal, rising above the ventrally situated osteophytes. In those patients with reversal of the cervical curve and swan neck deformities, posterior decompression has not been of value. Recent more radical procedures in such cases, such as vertebrectomy, remain to be evaluated. Any procedure which will permit further kyphotic deformity, such as laminectomy, is contraindicated. Eighty-five percent of the patients operated upon by the recommended surgical approach improved.

Adult↗
PubMed1982

Liquid crystal thermography of the spine and extremities. Its value in the diagnosis of spinal root syndromes.

Cholesteric liquid crystals are special compounds that display specific color changes in response to variations in temperature. Their responses can be graphically demonstrated by means of color thermography. A new color contract thermographic technique is described utilizing liquid crystals embedded in elastic flexible sheaths. These sheaths, when inflated, conform to the varied contours of the torso and extremities and, therefore, the new thermographic technique is especially well suited to the study of the skin dermatomes and myotomes. Typical heat patterns have been observed in root compression syndromes and particularly at the S-1, L-5, L-4, C-6, C-7, and C-8 levels. A high degree of anatomic accuracy can thus be achieved, comparable to or better than can be achieved by electromyography or myelography. Liquid crystal thermography can serve to screen patients for myelography and can complement myelography in identifying clinically significant abnormalities. The imaging technique correlates well with clinical and surgical findings, and constitutes one of the first attempts by means of a concomitant study of the body dermatomes to objectively document the subjective complaint of pain.

Adult↗
PubMed1981

Osteoid osteomas and osteoblastomas of the spine.

Benign osteoblastic lesions are rare bone tumors and they are usually divided into osteoid osteomas and benign osteoblastomas based on their biological behavior. Both lesions are prevalent in the spine, with the lamina and pedicle being involved frequently. Long diagnostic delays are frequent. Pain, the most prominent symptom, is often nocturnal and is relieved by aspirin in 30 to 40% of patients. Radicular pain occurs in 50% of the patients. The most common physical finding is tenderness in the vicinity of the lesion. Neurological abnormalities are more frequent in patients with osteoblastomas, which frequently extend into the neural canal. Tomograms are invaluable in most patients in whom plain films are normal. The bone scan is one of the most important diagnostic studies and provides an excellent means of accurately demonstrates the location and extent of the tumor. Permanent relief of pain and neurological recovery is dependent primarily on total removal of the lesion.

Adolescent↗
PubMed1981

Total myelography with metrizamide through the lumbar route.

Myelography of the entire spinal cord was performed in 64 consecutive patients using metrizamide via lumbar puncture. Adequate to good opacification of the cervical and thoracic subarachnoid space was obtained in 63 patients. The technical factors responsible for this success rate are patient cooperation, high iodine concentration, high iodine concentration (250 mg/ml), slow injection rate, delayed removal of the needle, minimal patient motion, and rapid performance. Side effects were minor and no more frequent than with lumbar metrizamide myelography alone. Adequate hydration before and after and upright position after seem to be important in minimizing adverse effects.

Adolescent↗
PubMed1981

Conjoined lumbosacral nerve roots. Management of herniated discs and lateral recess stenosis in patients with this anomaly.

Anomalous L-5 and S-1 nerve roots occur infrequently. If not properly recognized, surgery for entrapment disorders may result in serious neural injury because of an improper surgical approach in exposure and in removing the underlying herniated discs. The diagnosis has been made preoperatively since the introduction of water-soluble myelography because of improved filling of the nerve roots. A herniated disc beneath the bifid root causes extreme pain and disability with marked signs of entrapment because of firm fixation of the conjoined root in the lateral recess between the two pedicles. An underlying herniated disc may not be recognized because of the unique anatomical changes. To properly identify the nature of the lesion, wide exposure by hemilaminectomy is preferred, with unroofing of the lateral recesses and wide foraminal decompression. Eight such patients are reported: seven had herniated discs, and one had lateral recess stenosis with superior facet entrapment. With adequate decompression, all patients made a rapid, uneventful recovery.

Adult↗
PubMed1979

Cervical myelopathy caused by developmental stenosis of the spinal canal.

The authors present six patients with myelopathy caused by developmental stenosis of the cervical spine. Hyperextension injuries precipitated the onset of symptoms in two patients, aged 19 and 20 years. In four, 41 to 69 years of age, symptoms were gradual in onset, progressing to severe disability. X-ray films revealed narrowing of the dorsoventral diameter of the spinal canal to as little as 1.0 cm. The myelograms showed widening of the cord in the transverse plane strongly suggestive of an intramedullary tumor. A unique finding was maldevelopment with flattening of the neural arch often hidden by the posterior portions of the articular facets when seen in the lateral views. These patients showed no significant evidence of spondylosis, arthrosis, or any of the structural stigmata usually observed in cervical spondylotic myelopathy. When indicated, decompressive laminectomy is the treatment of choice.

Adult↗
PubMed1978

Lap-sash three point seat belt fractures of the cervical spine.

Cervical spine injuries associated with three-point fixation lap-sash seat belts result from impact against the sash. While such injuries are infrequent and often without serious neurologic sequelae, they may produce serious deficits with grave injuries. Flexion-extension fractures of the lower cervical vertebrae, fractures of the transverse and spinous processes of the lower cervical and uppermost thoracic vertebrae, discal disruptions, and brachial plexus avulsions may occur. Of the 3 patients reported here, 2 escaped serious damage.

Accidents, Traffic↗
PubMed1978

Obliterative arachnoiditis complicating lumbar spinal stenosis.

The authors report five patients with spinal stenosis who had a total myelographic block at the level of the obliterated subarachnoid space. Arachnoiditis had not been considered as a primary diagnosis until laminectomy revealed a non-pulsating, thickened dural sac that conformed to the internal configuration of the involved spinal canal. Two patients had stenosis complicated by spondyloarthrosis over multiple lumbar levels, one had a previous spinal fusion, another had degenerative spondylolisthesis, and the fifth had a large midline extruded disc at L2-3 that completely blocked the spinal canal. The dura was opened in two patients, confirming the lesion. Despite obliteration of the subarachnoid space, significant relief for approximately 1 year followed decompressive laminectomy, foraminotomy, and discectomy, with disappearance of neurogenic claudication in three patients. Postoperative erect films showed no caudad passage of contrast. While further observations are required, an awareness of this complication of spinal stenosis is important in the diagnosis and management of such patients and in evaluating their ultimate prognosis.

Aged↗
PubMed1978

Cervical myeloradiculopathy caused by arthrotic hypertrophy of the posterior facets and laminae.

Five patients with typical cervical myeloradiculopathy caused by focal cervical spinal stenosis are presented. Dorsal intrusions into the spinal canal by hypertrophied apophyseal joints and thickened laminae resulted in cord and nerve root compression. Minor spondylotic changes were present in the floor of the spinal canal. Laminar decompression with formainotomy and facetectomy relieved the patients of their symptoms. An anterior approach should not be considered in the management of this disorder. Our findings of severe apophyseal arthrosis with lesser degrees of associated spondylosis are similar to those described in anatomical studies by other authors. While uncommon, myelopathy caused by dorsal compression of the spinal cord and nerve roots deserves specific mention so that therapy can be directed to the proper quadrants of the spinal canal wherein the significant pathology is located.

Aged↗
PubMed1977

Clomiphene treatment in oligospermic infertile males.

This study of the effects of long-term clomiphene administration on semen analyses of oligospermic infertile males once again points to the potential therapeutic efficacy of clomiphene in certain subjects. Although the group of 16 subjects was small, all were men with long-standing infertility that had been refractory to previous treatments such as exogenous injections of human chorionic gonadotropin and varicocelectomy; 10 of the 16 men (62.5%) showed improvement in sperm counts within 2 to 5 months of starting clomiphene. Sperm motility improved moderately when counts improved; no effects on sperm morphology were noted. Of the 10 men classified as semen responders to clomiphene, 5 (50%) were successful in impregnating their wives within 2 to 8 months of starting treatment. These results approach the therapeutic efficacy seen with clomiphene in appropriately selected females with ovulatory disturbances. We have been unable to predict or characterize the patient who might be expected to show a semen response to clomiphene by history, physical examination response to previous treatment, or changes in blood testosterone levels while taking clomiphene.

Clomiphene↗
PubMed1977

Cervical spinal stenosis.

Cervical spinal stenosis occurs at the craniovertebral junction, usually incident to a congenital malformation, or it appears as a developmental defect with diffuse narrowing of the cervical canal. In its acquired form the lesion may be limited to one or two levels, or it may be more extensive and affect three or more segments.

Adult↗