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Biomedical subjects

J R Carter

Publications and source records attributed to J R Carter.

At least 73 records · Page 4Linked to original sources
PubMed1988

Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging.

The authors reviewed magnetic resonance (MR) images of 474 consecutive patients referred for lumbar spine MR imaging. Type 1 changes (decreased signal intensity on T1-weighted spin-echo images and increased signal intensity on T2-weighted images) were identified in 20 patients (4%) and type 2 (increased signal intensity on T1-weighted images and isointense or slightly increased signal intensity on T2-weighted images) in 77 patients (16%). In all cases there was evidence of associated degenerative disk disease at the level of involvement. Histopathologic sections in three cases of type 1 change demonstrated disruption and fissuring of the end plates and vascularized fibrous tissue, while in three cases of type 2 change they demonstrated yellow marrow replacement. In addition, 16 patients with end-plate changes documented with MR were studied longitudinally. Type 1 changes in five of six patients converted to a type 2 pattern in 14 months to 3 years. Type 2 changes in ten patients remained stable over a 2-3-year period. These signal intensity changes appear to reflect a spectrum of vertebral body marrow changes associated with degenerative disk disease.

Adult↗
PubMed1988

Lumbar spine: postoperative MR imaging with Gd-DTPA.

Thirty patients with failed back surgery syndrome were studied to evaluate the effectiveness of magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepentaacetic acid/dimeglumine (Gd-DTPA) in differentiating postoperative epidural fibrosis (scar) from recurrent disk herniation. Pre- and postcontrast MR images were interpreted without access to other diagnostic, surgical, or pathologic findings. Seventeen patients had surgical and pathologic correlation of the MR findings at 19 disk levels. The precontrast studies had a sensitivity, specificity, and accuracy of 100%, 71%, and 89%, respectively. The enhanced MR studies correctly depicted the character of abnormal epidural soft tissue in 17 patients at all 19 levels. Scar showed heterogeneous enhancement on the early T1-weighted spin-echo images obtained within 10 minutes after contrast material administration. Herniated disk did not show significant enhancement on the early studies but showed variable degrees of enhancement on delayed images in nine of 12 cases. Other criteria were found to be less useful than the pattern of enhancement. Results indicate that precontrast and early postcontrast T1-weighted spin-echo studies are highly accurate in separating epidural fibrosis from herniated disk.

Adult↗
PubMed1988

Intramedullary osteosclerosis. A report of the clinicopathologic features of five cases.

The clinicopathologic features of five patients with intramedullary osteosclerosis are presented. The patients, ranging in age from 8 to 52 years (mean 31 years), all presented with pain referred to the lower extremity. The sclerotic lesions involved the entire lower extremity in 1 patient, mid-tibial shaft in 2, distal tibia in 1, and distal fibula in 1 patient. The histopathologic features of intramedullary osteosclerosis overlap with those of melorheostosis. The differential diagnosis also includes a spectrum of entities, each characterized by osteosclerosis and each of which is compared and contrasted to the cases presented.

Adolescent↗
PubMed1987

Multiplicity of neurilemomas in the upper extremity.

Multiple neurilemomas in two patients show that these tumors may indeed be multiple, may involve the same nerve trunk, may occur over a period of years, and may involve different regions of the body. Twelve neurilemomas were removed from the right upper extremity of a patient over a 3-year period. They varied in size from 0.5 cm to 4 cm in diameter and had the typical histopathologic appearance of neurilemomas. The second patient had median nerve compression and at operation a neurilemoma was found compressing the nerve. Two years later, the patient had evidence of median nerve compression in the opposite extremity, and again a neurilemoma was found. Both of these patients had evidence of peripheral nerve compression, but the existence of multiple neurilemomas was not apparent on initial examination. These cases show that patients with neurilemomas may have additional sequential tumors discovered at a later date that were not apparent initially.

Aged↗
PubMed1987

Vertebral hemangiomas: MR imaging.

Vertebral hemangiomas, unlike most bone lesions, show increased signal on T1- and T2-weighted magnetic resonance (MR) images. To define the basis for these signal characteristics, a retrospective review was done of the MR imaging findings in ten vertebral hemangiomas (eight patients), and these were correlated with the findings from plain radiographic, computed tomographic (CT), and histopathologic studies. MR images showed mottled increased signal in T1- and T2-weighted images from the osseous portions of the tumors. In three patients, the extraosseous components failed to show increased signal on T1-weighted images. Chemical shift images and histologic studies demonstrated that adipose tissue caused the increased signal on T1-weighted images. The extraosseous components of the tumor contained little, if any, adipose tissue, which explained the lack of high-intensity signal on T1-weighted images. These signal changes appear to make a specific constellation of findings for the diagnosis of vertebral hemangioma with MR imaging.

Adult↗
PubMed1986

Metastatic skeletal disease distal to the elbow and knee.

Metastatic disease of bone is the most common example of "bone cancer." The incidence of skeletal metastases varies from 6% to 85% depending on the primary tumor and the method of evaluation. Axial skeletal involvement is more common than appendicular involvement, and metastatic lesions below the elbow and knee are relatively uncommon. Fifty-seven autopsy subjects had had clinical evidence of metastatic involvement below the knee and elbow with an incidence of 7% (57/827). The lung was the most common primary site, and the tibia was the most common bone affected. Pain, local soft-tissue extension, and pathologic fractures were the most common presenting symptoms. Prior to 1960, most patients did not receive treatment. Until recent intervention, no treatment was offered to enhance the quantity or quality of patient survival.

Adolescent↗
PubMed1986

Eosinophilic granuloma of bone.

Eosinophilic granuloma of bone as a component of the syndrome histiocytosis X is discussed with respect to clinical, pathologic, and radiologic diagnostic biases and discrepancies employing illustrative case material. The subject is reviewed in historical perspective selectively, with emphasis on those features that may serve as a valuable resource in evaluating initial patient presentations and subsequent follow-up evaluation. Salient pathologic and pathogenetic considerations especially germane to clinical phenomena are reviewed, and current therapeutic modalities are summarized.

Adolescent↗
PubMed1986

Primary neoplasms of the cervical spine. Diagnosis and treatment of twenty-three patients.

The records of twenty-three patients with a primary benign or malignant osseous neoplasm of the cervical spine were reviewed in an attempt to clarify the most appropriate diagnostic and treatment methods for such tumors. Thirteen patients had a benign tumor and ten patients had a malignant tumor. Nineteen patients had been followed for two to eighteen years (average, six years), and four had died from the malignant disease between one and five months after its discovery. In addition to surgery, medical treatment in the ten patients with a malignant tumor included radiation therapy in seven and chemotherapy in two. Surgical treatment consisted of an anterior and posterior partial resection combined with an arthrodesis in four patients; an anterior partial resection in three, two with an arthrodesis; a posterior partial resection and an arthrodesis in two; and a biopsy but no further treatment in one patient. The duration of survival ranged from one to five months for four patients and from two to three years for four, and was eight and sixteen years in two patients. Two of the thirteen patients with a benign tumor received radiation therapy. Surgical treatment included both an anterior and a posterior resection with arthrodesis in four, an anterior resection in three (with arthrodesis in two), a posterior resection in four (with arthrodesis in three), and a biopsy without surgical resection in two. At follow-up, twelve patients were pain-free and had a solid arthrodesis, although one had required a repeat excision posteriorly. One patient with Gorham's disease (diffuse hemangiomatosis) died. During the period of thirty years (1953 to 1983) when these patients were seen, both the diagnostic methods available and the surgical approaches used have changed. Our present opinion is that all primary osseous lesions of the cervical spine should be carefully defined by arteriography, tomography, bone-scanning, computed tomographic scanning, and myelography in order to properly plan the surgical approach. Total excision of suspect malignant lesions is not attempted, but a major intralesional excision should be carried out to decompress neural and vascular structures and to obtain a biopsy specimen, followed by an arthrodesis to stabilize the spine. For both malignant and benign tumors, an anterior resection should be performed if the tumor is located anteriorly, and a posterior approach should be used if the tumor is predominantly in the posterior vertebral elements. Both of these procedures should be combined with an arthrodesis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

Primary amyloidoma of the spine. A case report and review of the literature.

Primary amyloidosis of bone is a rare disease process. When amyloid lesions do occur in bone, they are often associated with myeloma or other plasma cell dyscrasias. Because of its rarity and its protean clinical and radiographic picture adequate biopsy tissue for histopathologic studies is essential for accurate diagnosis. This case presents a 43-year-old man with nondescript back pain and an impressive radiographic lesion in his lower thoracic spine demonstrating the need for careful diagnostic evaluation and a high incidence of suspicion. When occurring primarily in a localized anatomic area, the prognosis for survival is excellent, and cure can be expected by local excision and reconstruction, as necessary.

Adult↗
PubMed1985

The National Autopsy Data Bank.

The National Autopsy DAta Bank was conceived by the CAP in 1975 as a central repository of pathologic, biomedical, demographic, and epidemiologic information useful for a range of scientific and research endeavors. Successful phase I and phase II pilot studies have demonstrated that central autopsy data collection is feasible and desirable. In addition, the inconsistent quality and lack of uniformity in performing and reporting autopsies has led to the establishment of new objectives. Here, the authors trace the development of the NADB, reveal what has been learned from the studies, and highlight the directions in which the project is heading.

Autopsy↗
PubMed1984

Late-onset tibia vara: a comparative analysis.

We reviewed the clinical and radiographic characteristics and response to treatment of 11 children (16 knees) with idiopathic late-onset tibia vara (adolescent Blount's disease) followed for an average of 5.7 years (range, 3-10 years). The clinical characteristics were very consistent: black race; 2:1 male predominance; normal height; marked obesity; knee pain as the primary presenting complaint; and slowly progressive genu varum deformity that averaged 19 degrees (range, 10-45 degrees). Radiographically, the epiphyses were wedge shaped owing to medial flattening, the physes were irregular in thickness, and there was minimal, if any increased prominence of the proximal medial metaphysis. Nineteen proximal tibial valgus and diaphyseal fibula osteotomies were performed on 15 knees. There was a 50% rate of recurrent deformity in males with clinical onset at less than or equal to 10 years of age. Females and older males had no recurrences. Histopathologic studies of the physis performed on one case demonstrated abnormal cellular islands of hyaline cartilage, small foci of necrotic cartilage, prominent intertrabecular vascularity, and premature medial physeal closure. These data support late-onset tibia vara as a distinct entity closely related to the infantile form. They also suggest three specific forms of tibia vara based on the age at clinical onset: infantile (0-3 years), juvenile (4-10 years), and true adolescent (11 years or older). The juvenile group is characterized by a high rate of recurrence following surgical correction, whereas the others are not.

Adolescent↗
PubMed1983

The ultrastructural heterogeneity of the Reed-Sternberg cell and its resemblance to monocyte-macrophage differentiation in vivo.

Hodgkin's disease is a malignant neoplasm that shares many histologic features with granulomatous diseases. We have examined 11 cases of Hodgkin's disease, representing the spectrum of histologic types, using transmission electron microscopy and have compared the morphology of Reed-Sternberg cells to that of the developmental stages described for monocyte-macrophage differentiation in vivo. Ultrastructurally, a close parallelism exists between the cells that typify granulomatous inflammation and Reed-Sternberg cells. It is our contention that the heterogeniety among Reed-Sternberg cells in all types of Hodgkin's disease parallels the diversity of the monocyte-macrophage system.

Cell Differentiation↗
PubMed1981

Toxic shock syndrome: clinicopathologic findings in a fatal case.

A 15 year old girl presented with a painful desquamative rash, fever, and profound hypotension. Despite antimicrobial therapy and intensive supportive measures, she died 80 hours after admission. The premortem skin biopsy and autopsy findings, which included subepidermal edema and blister formation, subacute vasculitis, and striking interstitial edema involving several organs, are consistent with a toxin mediated process. Current knowledge of the pathogenesis of the toxic shock syndrome and its differential diagnosis are discussed in light of the clinicopathologic findings in this case.

Adolescent↗