Biomedical subjects
Publications and source records attributed to J D Laredo.
We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively.
PURPOSE: To study the results of facet joint intraarticular steroid injections in patients with symptomatic lumbar facet joint synovial cysts. MATERIALS AND METHODS: Data from 30 patients (age range, 44-82 years; mean age, 67 years) with nerve root pain due to a lumbar facet joint synovial cyst and treated with facet joint steroid injection were retrospectively studied. On the basis of MacNab criteria, the clinical course of nerve root pain was evaluated after 1 (n = 30) and 6 (n = 28) months. Data from long-term follow-up (mean, 26 months) were also available in 14 nonsurgically treated patients. RESULTS: After 1 month, the nerve root pain outcome was excellent or good in 20 patients (67%) and fair or poor in 10 (33%). After 6 months, 10 (50%) of these 20 patients still had excellent or good results, and 18 (60%) of the 30 patients had a fair or poor clinical status, 14 of whom underwent surgery; two patients (7%) were lost to follow-up. Excellent and good results were maintained at further follow-up (range, 9-50 months). CONCLUSION: One-third of patients with symptomatic lumbar facet joint synovial cysts had long-lasting acceptable benefit from facet joint steroid injections in this study. Steroid injection should be indicated before surgery.
OBJECTIVE: We describe an intravertebral fluidlike collection observed on MR images in five of six patients who sustained vertebral body fracture through a segment of the spine ankylosed by diffuse idiopathic skeletal hyperostosis. The mechanism of injury, clinical course, conventional radiographs, CT scans, and other MR imaging findings are analyzed. CONCLUSION: Intravertebral fluidlike collections were associated with hyperextension injury of the spine. Well-delineated borders, anterior widening, and associated posterior-element injury are the main MR imaging characteristics of this trauma-related intravertebral fluidlike collection.
Explore the source record for details and available documents.
OBJECTIVE: To demonstrate the contribution of magnetic resonance imaging to the elucidation of mechanisms involved in "osteonecrosis-like syndrome of the medial tibial plateau". PATIENTS AND METHODS: A magnetic resonance study with sagittal and coronal sections was done in 13 patients (age range, 57-95 years) two weeks to four months into a painful syndrome meeting the definition of "osteonecrosis-like syndrome of the medial tibial plateau". Gadolinium injection was used in nine patients. Clinical symptoms resolved within a few weeks in all 13 cases. RESULTS: T1-weighted images without gadolinium showed diffuse low signal from the epiphysis (n = 12) containing an area of even lower signal seen either as a crescent-shaped subchondral image (n = 3/12) or as a linear image (n = 9/12). On postgadolinium images, the low signal was abolished except for a line of low signal parallel to the subchondral bone. T2-weighted images demonstrated diffuse high signal from the medial tibial plateau with persistence of the line of low signal (n = 8/12). CONCLUSION: Magnetic resonance imaging allows to analyze the anatomic lesion responsible for "osteonecrosis-like syndrome of the medial tibial plateau". Our magnetic resonance findings were similar to those seen in stress fractures at other sites.
The acetabulum is a rare location for osteoid osteoma. Conventional surgery of such lesions may require either a large bone resection, an arthrotomy, or a hip dislocation. This report describes the technique and results of percutaneous lesion removal using computed tomography guidance in three osteoid osteomas of the acetabulum. Histologic confirmation was obtained in the three cases. The three patients experienced complete pain relief with a mean followup of 36 months.
Explore the source record for details and available documents.
In most cases, osteoid osteomas can be removed through a percutaneous approach. The authors report their experience of percutaneous removal of osteoid osteomas under CT guidance. The literature on percutaneous treatments of osteoid osteomas is reviewed. The respective advantages of percutaneous removal and percutaneous destruction of the nidus using thermocoagulation or interstitial laser photocoagulation are discussed.
Percutaneous treatments are useful in two, frequent, painful conditions involving the shoulder. In frozen shoulder syndrome, distention arthrography with intra-articular injection of steroid is used to provide pain relief and to improve joint motion. In rotator cuff tendon calcifications, needle aspiration of calcific deposits is used to treat pain. Surgery should be restricted to failures of needle aspiration. The techniques of these procedures are described and their results are reported.
Explore the source record for details and available documents.
OBJECTIVE: The technique and results of a special oblique radiograph of the hip called the "faux profil" (FP) of the hip are described. The FP was evaluated for the detection of joint space narrowing in incipient osteoarthritis of the hip (OAH) as compared with the anteroposterior (AP) radiograph. METHODS: 58 hips with incipient osteoarthritis (joint space narrowing, 0-25% on the AP view) in 48 patients were identified among 200 consecutive patients fulfilling American College of Rheumatology criteria for OAH. Joint space narrowing was measured on the AP and FP radiographs of these 58 hips. RESULTS: The FP view provides a true lateral projection of the femoral head and neck, and an oblique view of the acetabulum tangential to its superoanteromedial edge. On this view, the width of the anterosuperior and posteroinferior parts of the joint space can be measured and compared. Among the 58 hips with incipient OAH, 36 (62%) showed joint space narrowing on the AP view and 51 (91%) on the FP view. Among the 22 hips without joint space narrowing on the AP radiograph, 16 (72.7%) showed joint space narrowing on the FP view, involving the anterosuperior part of the joint in 11 cases and the posteroinferior part in five cases. CONCLUSION: The FP view in the standing position should be used in incipient OAH as a complement to the AP view in patients with suspected OAH but no joint space narrowing on the AP radiograph. In this situation, nearly three quarters of hips in the study had joint space narrowing on the FP view, usually in the anterosuperior part and less often in the posteroinferior part of the joint.
Explore the source record for details and available documents.
STUDY DESIGN: A prospective multicenter study. OBJECTIVES: To evaluate the use of magnetic resonance imaging, in the differentiation between monoclonal gammopathies of unknown significance and multiple myeloma. SUMMARY OF BACKGROUND DATA: Although multiple myeloma has been studied extensively with magnetic resonance imaging, to the authors' knowledge, no study has evaluated the clinical interest of magnetic resonance imaging in the differentiation between monoclonal gammopathies of unknown significance and multiple myeloma. METHODS: The magnetic resonance examinations of the thoracolumbar spine in 24 patients with newly diagnosed monoclonal gammopathies of unknown significance were compared with those performed in 44 patients with newly diagnosed nontreated multiple myeloma. RESULTS: All findings on magnetic resonance examination performed in patients with monoclonal gammopathies of unknown significance were normal, whereas findings on 38 (86%) of the 44 magnetic resonance examinations performed in patients with multiple myeloma were abnormal. CONCLUSION: Magnetic resonance imaging can be considered as an additional diagnostic tool in differentiating between monoclonal gammopathies of unknown significance and multiple myeloma, which may be helpful when routine criteria are not sufficient. An abnormal finding on magnetic resonance examination in a patient with monoclonal gammopathies of unknown significance should suggest the diagnosis of multiple myeloma after other causes of marrow signal abnormalities are excluded. Magnetic resonance imaging also may be proposed in the long-term follow-up of monoclonal gammopathies of unknown significance when a new biologic or clinical event suggests the diagnosis of malignant monoclonal gammopathy.
Explore the source record for details and available documents.
Cysts of the glenoid labrum are ganglia cysts extending near the glenohumeral joint with frequent clinical signs and symptoms of a compression of the subscapularis nerve. They are detected through MR examination. They are frequently associated to instability of the glenohumeral joint.
Cervical myelography is obtained after injection of contrast medium into the lumbar subarachnoid space through a lumbar puncture. The patient is prone with a large radiolucent block under the pelvis so that the site of lumbar puncture is at a higher level than that of the cervical spine lordosis. Lumbar contrast is injected gently so that the contrast fluid slides along the ventral aspect of the dural sac and immediately reaches the cervical subarachnoid space. Then AP and lateral (with a horizontal X-ray beam) views are obtained. The patient has to remain firmly immobilized during the whole procedure to avoid blending of the contrast medium with CSF. This procedure is safe and allows cervical myelography to reach the same quality as that obtained through cervical puncture.
Interrogation of patients still painful after lumbar intervertebral disk surgery provides with a series of informations each of them having only an indicative value, while they altogether compound a score helping assess the presence or the absence of a recurring disk herniation.