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Biomedical subjects

J L Drape

Publications and source records attributed to J L Drape.

14 recordsLinked to original sources
PubMed2001

Measurement of joint space width in hip osteoarthritis: influence of joint positioning and radiographic procedure.

OBJECTIVES: We assessed the influence of patient positioning and radiographic procedure, and defined a smallest detectable difference (SDD) in hip osteoarthritis (OA). METHODS: OA hip patients each had a standardized pelvic radiograph and, 5 min later, a modified pelvic radiograph with the feet internally rotated 5 degrees (part 1 of the study), the X-ray beam centred on the umbilicus (part 2), or another standardized pelvic radiograph (part 3). RESULTS: Corresponding mean differences in joint space width (JSW) measurements (limits of agreement) between views were +0.03 (-0.53 to +0.59), -0.31 (-1.15 to +0.53) and -0.02 (-0.48 to +0.44) mm. The two views differed significantly in mean JSW in part 2 of the study (P=1.6x10(-4)), but not in part 1 (P=0.375) and part 3 (P=0.580). The SDD estimate was 0.46 mm. CONCLUSIONS: Modifying the X-ray beam and foot rotation increases variability in JSW measurements. Use of urograms to evaluate radiological progression should be avoided. A change greater than 0.46 mm could define radiological hip OA progression.

Aged↗
PubMed1998

Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis.

OBJECTIVES: (1) To assess reproducibility of medial knee joint space width (JSW) measurement in healthy subjects and osteoarthritic (OA) patients. (2) To define minimal relevant radiological change in knee JSW based on the reproducibility of its measurement. PATIENTS AND METHODS: (1) Healthy volunteers: in the first part of the study, 20 knees of healthy adult volunteers were radiographed in the weightbearing, anteroposterior extended view, twice, two weeks apart, using three different radiographic procedures: (a) without guidelines, (b) with guidelines and without fluoroscopy, (c) with guidelines and fluoroscopy. (2) Knee OA patients: in the second part of the study, 36 knees of OA patients were radiographed twice with guidelines and without fluoroscopy. JSW was measured blindly using a graduated magnifying glass. Based on the Bland and Altman graphic approach, cut off points defining minimal relevant radiological change are proposed. RESULTS: Standard deviation (SD) of differences in JSW measurement between two sets of knee radiographs in healthy subjects were 0.66 mm for radiography performed without guidelines, 0.37 mm for radiography performed with guidelines and without fluoroscopy, and 0.31 mm for radiography with guidelines and fluoroscopy. SD of differences in JSW measurement in OA patients were 0.32 mm for radiography performed with guidelines and without fluoroscopy. A minimal relevant change in JSW between two radiographs performed in healthy subjects can be defined by a change of at least 1.29 or 0.59 mm when radiographs are taken without guidelines, and with guidelines and fluoroscopy, respectively. When radiographs are taken with guidelines and without fluoroscopy, the change must be at least 0.73 mm. A similar figure, 0.64 mm was observed in knee OA patients. CONCLUSION: Definition of radiological progression varies greatly according to the radiographic procedure chosen. Use of guidelines reduces the threshold of progression required to consider that change between two measures is relevant.

Adult↗
PubMed1996

CT scans and arthro-CT scans.

The study of the cartilage is relatively easy with modern imaging. If the interpretation of MRI cartilage remains difficult arthro-CT images are easy to obtain. Arthro-CT is much preferable to simple arthrography. These two steps are in fact complementary: the global study of the joint is made with arthrography while the accurate assessment of cartilage is obtained with thin CT native slices acquired in an adapted plane and completed with reformatted images. The detection of small lesions, such as a faint thinning of the cartilage, or a focal fissure is only possible with a long and meticulous examination. The pathological value of the images still depends on the clinical examination, because of the high incidence of asymptomatic chondromalacia in elderly patients. The assessment of the cartilage overlying osteochondritis or osteochondral fractures is of particular clinical interest. The detection of post-traumatic cartilaginous lesions may also be valuable in medicolegal problems.

Arthrography↗
PubMed1994

Magnetic resonance imaging: a new tool in the diagnosis of tumours of the nail apparatus.

Tumours of the nail apparatus are often the subject of diagnostic dilemma. Until now, no reliable imaging methods have been available to assess these lesions correctly. We report the results of high and very high-resolution magnetic resonance imaging (MRI), which have been correlated with the anatomical findings in 14 cases of nail apparatus pathology, and discuss the possible contribution of MRI to diagnosis. With very high-resolution MRI, accurate analysis of the anatomy of the nail apparatus is possible, and lesions as small as 1 mm can be detected. An expansive process can be excluded when results are negative. Glomus tumour, mucoid pseudocyst, fibrokeratoma, and exostosis can be differentiated because of their different MRI characteristics. This is of importance when the exact nature of a subungual tumour cannot be determined by clinical findings alone. Measurement, determination of the exact localization of the tumour, and the study of its relationship to the other structures, can provide guidance for subsequent surgical procedures. MRI is reliable and accurate in the delineation of lesions, and provides a new tool for the investigation of pathology of the nail apparatus.

Adolescent↗
PubMed1994

[Villonodular synovitis of the knee. Contributions of MRI].

This retrospective study included eight patients with villonodular synovitis of the knee (7 nodular forms and one villous form) who underwent magnetic resonance imaging and at least one arthroscopy. Joint enlargement and mild pain were the main manifestations. Other imaging studies provided little information. Magnetic resonance imaging showed highly suggestive hemosiderin-laden masses. Hemosiderin was most clearly seen on gradient echo sequences. Magnetic resonance imaging was also useful for determining the distribution of lesions. Intravenous gadolinium provided no additional information. Arthroscopy allowed to collect biopsy specimens and to perform synovectomy when called for. In our opinion, after a physical examination and plain roentgenograms, magnetic resonance imaging and arthroscopy should both be performed to determine the extent of lesions and to allow histological diagnosis and synovectomy, respectively.

Adolescent↗
PubMed1993

Cervical nucleolysis: indications, technique, results. 190 patients.

For many years now percutaneous techniques have proved effective in the curative treatment of lumbar disc herniation, mostly in young subjects. This technique, however, is seldom indicated, let alone performed, in the cervical spine for a variety of reasons: a) the neck contains several closely arranged structures such as the vasculo-nervous bundles, the airway-digestive tract and the cervical spine around the spinal cord; b) the disc is approached by the anterior route, in contrast with the lumbo-sacral spine where the approach is posterolateral; c) the manufacturers insist on restrictions in the use of chymopapain in view of the potential risk of spinal cord damage, either by possible breaks in the meninges of by accidental diffusion of the enzyme into perimedullary epidural structures which support a particularly developed venous plexus; d) legal protection may be denied to operators who perform cervical chemonucleolysis, since the product has not yet been officially authorized, in France and perhaps elsewhere*, for treatment of cervical disc herniation. Several years of experience in the practice of cervical nucleolysis have convinced the authors that this method is remarkably effective and can be used in the treatment of cervicobrachial neuralgia (CBN) occurring in young subjects. Radiculalgia is essentially due to a disc fragment being positioned within the vertebral canal or a foramen, thereby compressing the nerve roots. During several years microsurgery of the disc has been effective in the treatment of refractory radiculalgia, and to compete with this procedure familiar to neurosurgeons cervical nucleolysis must convincingly demonstrate that its therapeutic value is at least as good as that of surgery. Finally, the vast majority of cervical disc herniations is made up of free disc fragments located within the meshes of the posterior longitudinal ligament of the spine (transligamentous fragment). Cervical nucleolysis was introduced in France by Bonafe and Lazorthes made enthusiastic by their first studies, and the idea of this procedure, developed by a radio-neurosurgical team, has gradually been gaining ground. The decision to intervene is made when the radiculalgia is recurrent or resistant to a well-conducted medical treatment of several weeks duration. Therefore all disc herniations that would have been treated surgically can be treated by injection of an enzyme. This point is very important, and in fact the well-codified and effective surgical procedure has progressively been abandoned by the operators, in view of the simplicity of nucleolysis and the rapid pain relief it procures.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

MRI of aggressive meningiomas.

The authors have attempted to establish by MRI morphological criteria for the so-called "aggressive" intracranial meningiomas. The MRI features of 20 meningiomas histologically aggressive (numerous mitoses and small necrotic foci) or malignant (same plus invasion of the subjacent brain tissue) were compared with those of a control population of 26 patients with benign meningioma. The site of the tumour and its histological type had little predictive value, but there was a remarkably high proportion of male patients in the group with aggressive meningioma (9/20 versus 2/26). More than other varieties, aggressive meningiomas frequently emitted, on both T1- and T2-weighted sequences, a heterogeneous signal due to a necrotic focus (P less than 0.01). The high-intensity signal observed on T2-weighted sequences (11/20) was suggestive of syncitial or angioblastic meningioma. Cystic meningiomas were present in virtually equal proportions (3/20 versus 3/26) in the two populations and could raise problems concerning the diagnosis of nature, especially when intraventricular. Gadolinium injection provided further evidence of aggressiveness, such as irregular tumour outline or even contrast enhancement of brain tissue in malignant cases (3/4), but enhancement of the dura mater was equally frequent in both groups (P greater than 0.2). Massive peritumoral oedema was significantly more frequent in aggressive melanomas (P less than 0.01).

Adolescent↗
PubMed1987

[Value of small intestine transit by enteroclysis in obstructive syndromes of the small intestine. Apropos of 212 examinations].

During seven years, 212 small bowel examinations are made on patients with suspected small bowel obstruction by barium infusion. We find all the main small bowel pathology: Crohn's disease (16.5%), carcinomatosis (14.6%), neoplasia (10.3%), vascular disease (17.8%), actinic enteritis (9.5%) and miscellanous (18%). The small bowel infusion is normal in 15%. Surgery is avoided in 51% of the cases. There is non complications associated with the examination but in 12% of the cases, the examination is unsuccessful.

Acute Disease↗
PubMed1986

Soft cervical disc herniations.

The authors report their findings in a series of 51 patients suffering from typical cervical radiculopathy. With the aid of the CT scanner and intravenous injection of a contrast medium, the quality and resolution of the resulting images allowed neurosurgical intervention in 42 patients in whom the symptomatology alone was not sufficiently informative to allow successful treatment. In most cases the CT images allowed an accurate diagnosis and revealed a free fragment that had torn the common posterior vertebra ligament.

Adult↗
PubMed1986

[Echographic aspects of Crohn's disease. Apropos of 42 studies].

Thirty two patients with confirmed Crohn's disease were examined from october 1983 to may 1985 by ultrasound (42 examinations) and by Conventional Contrast Radiology (Barium Contrast Studies). The well-know "target" pattern is the most frequent feature (88%) which is characteristic of the thickening bowel wall. The thickening is more important for the small bowel wall than the large bowel wall. But the "target" pattern is not the single pattern of inflammation involving the bowel. We also find a "rosette" pattern. This third ring is hypo or hyperechogenic or more complex. Other infrequent features are noted: solid abdominal masses, distended loops, luminal narrowing, fistula and stiffness. Because sonography is noninvasive and simple to perform without radiation exposure, it must often be used as the initial diagnostic tool and as the follow-up test for young people.

Adolescent↗
PubMedDate not supplied

Lumbar facet joint arthrography with the posterior approach.

Lumbar facet joint (LFJ) arthrography with intraarticular injections of long-acting steroids and local anesthetics is routinely used for therapeutic purposes in selected patients for relief of low back pain. The procedure may also be used for diagnostic reasons to establish the source of such pain. However, because direct access to the LFJ space is not always possible owing to degenerative changes such as osteophytes, another posterior approach has been proposed for LFJ arthrography. With the patient in the prone position, a spinal needle is inserted vertically into the inferior recess of an LFJ with fluoroscopic guidance and the patient under local anesthesia. To facilitate puncture, cushions are placed under the patient's abdomen to flatten normal lumbar lordosis, which enlarges the inferior recess of the LFJ. Use of cushions also results in a decrease in tissue thickness in the patient, thereby improving image quality and decreasing radiation exposure. LFJ arthrography can demonstrate the causative role of facet disease in abnormalities responsible for low back pain or sciatica and can be performed easily and rapidly with this direct posterior approach.

Anesthetics, Local↗
PubMedDate not supplied

[Chordoma of the base of skull in children. Apropos of a case].

Chordoma of base of skull is a rare tumor in children. The case reported was atypical by its slow course, the initial clinical signs resulting from the development of the tumoral process in the posterior fossa at the level of the petrous and pontocerebellar angle. Neuro-ophthalmologic manifestations appeared at a late stage only.

Child↗