Search PubMed⌕ Search

Biomedical subjects

J T Halla

Publications and source records attributed to J T Halla.

At least 19 recordsLinked to original sources
PubMed1995

Cervical spine and radicular pain syndromes.

Neck pain may affect one third of the adult population from time to time and may persist for 6 months or longer in 10% to 15% of these patients. In addition, cervical spine disease or trauma may result in injury to the spinal cord or nerve roots, through a variety of mechanisms, leading to a group of syndromes that can be broadly classified as myelopathy or radiculopathy. This review addresses recent developments in the anatomy and physiology of the normal cervical spine, common ill-defined or miscellaneous neck pain problems, and cervical injuries, with emphasis on the flexion-extension injury called "whiplash." Other types of injuries, including fractures and fracture dislocations, also are discussed, as well as neurologic consequences of cervical disk and facet joint degenerative disease, with emphasis on cervical spondylitic myelopathy. The complications of inflammatory joint diseases such as ankylosing spondylitis and rheumatoid arthritis are not specifically addressed in this review.

Humans↗
PubMed1994

Underrecognized postdosing reactions to methotrexate in patients with rheumatoid arthritis.

OBJECTIVE: To report previously underrecognized postdosing side effects of methotrexate (MTX). METHODS: Over a one and a half year period, in 2 practices, all patients with rheumatoid arthritis (RA) receiving weekly MTX, and volunteering symptoms within a few hours of MTX dosing were carefully questioned concerning the nature of the postdosing reaction. RESULTS: Of 356 patients, 36 (10%) reported a previously underemphasized postdosing reaction consisting of arthralgias/myalgias, fatigue/malaise or both. Sixteen patients discontinued MTX primarily because of this side effect. CONCLUSION: In these patient populations, postdosing reactions were the 2nd most common side effect (after gastrointestinal) leading to MTX withdrawal.

Administration, Oral↗
PubMed1991

Septic arthritis of the C1-C2 lateral facet joint and torticollis: pseudo-Grisel's syndrome.

We present the case of a 76-year-old man who experienced the sudden development of fever, rightsided neck pain and stiffness, and torticollis. A soft tissue mass was noted on the right side of his neck, but his head was tilted to the left. Computed tomography scans (with reformatted sagittal and coronal images) of the patient's cervical spine revealed destructive changes of the right lateral masses of C1 and C2 and the clivus, and a well-delineated peridontoid soft tissue mass (confirmed by magnetic resonance imaging). After the second episode of right-sided hemiparesis, he underwent transoral surgical exploration, with anterior decompression and odontoidectomy. Histologic examination of the surgical material revealed granulation tissue, fibrosis, and chronic inflammation, consistent with abscess formation with invasion and compression of the spinal cord and bone. This case suggests that nonreducible rotational head tilt to the side opposite the side of lateral mass collapse should raise the suspicion of a possible infection.

Aged↗
PubMed1991

Symptomatic salicylate ototoxicity: a useful indicator of serum salicylate concentration?

A three phase study was designed to define further the sensitivity and specificity of symptomatic salicylate ototoxicity (primarily tinnitus) for serum salicylate concentrations. In phase one 260 patients with osteoarthritis and 112 with rheumatoid arthritis, none taking salicylates, were interviewed about their ear symptoms. Their responses were not significantly different from those of 134 salicylate treated patients with rheumatoid arthritis previously reported. In the second phase 56 patients who were taking salicylates, and who volunteered the complaint of tinnitus, had serum salicylate concentrations measured while symptomatic, and 30 (54%) had concentrations less than 1.3 mmol/l. Few tolerated an upward salicylate dose adjustment. For phase three, 94 patients were found to have a salicylate concentration above 2.2 mmol/l on one or more occasion, and these subjects were interviewed. Fifty two patients (55%) had no tinnitus, and tinnitus correlated with the blood salicylate concentration in only 28 (30%). Audiological evaluation of most of the symptomatic patients was carried out, and results were abnormal in the majority, even in those patients not reporting tinnitus. Symptomatic salicylate ototoxicity is too nonspecific and too insensitive to be a useful indicator of serum salicylate concentration.

Adult↗
PubMed1990

The spectrum of atlantoaxial facet joint involvement in rheumatoid arthritis.

Six hundred fifty outpatients with rheumatoid arthritis (RA) were evaluated and followed up during a 7-year period. As part of their routine evaluation or because of neck-shoulder girdle symptoms, 48% of the patients underwent routine cervical spine radiography. Sixty-one RA patients (9% of the total population) had C1-C2 involvement. Compared with the 589 patients with no evidence of C1-C2 involvement, these 61 patients were significantly more likely to be younger, female, and seropositive, and they had significantly more nodules and erosions, as well as a longer disease duration. Based on radiographic evidence of C1-C2 disease severity, 3 groups emerged. Group 1 (28 patients) had lateral mass collapse, group 2 (27 patients) had lateral facet joint sclerosis, erosion, or loss of joint space with no collapse, and group 3 (6 patients) had lateral subluxation with no bone or cartilage changes. Nine patients in group 1 had severe pain, and 25 had a nonreducible rotational tilt of the head. None of the patients in the other 2 groups had either of these signs or symptoms. Moreover, patients in group 1 were more likely to have other C1-C2 or subaxial subluxations and were more likely to have myelopathy. C1-C2 lateral facet joint involvement is common in RA, correlates with disease severity generally and specifically with that in the cervical spine, and, when severe, causes nonreducible rotational tilt of the patient's head.

Aged↗
PubMed1990

Septic olecranon bursitis caused by Neisseria sicca.

A man with rheumatoid arthritis developed a septic olecranon bursitis due to Neisseria sicca. This case confirms the potential pathogenicity of Neisseria sicca and emphasizes that positive cultures for this organism should not be readily dismissed.

Arthritis, Rheumatoid↗
PubMed1989

Clinical characteristics affecting survival in patients with rheumatoid arthritis undergoing cervical spine surgery: a controlled study.

A controlled study of the clinical characteristics affecting survival in patients with rheumatoid arthritis (RA) with cervical spine involvement treated surgically demonstrated a strong association between disease severity, the frequency of severe extraarticular manifestations, especially interstitial lung disease, and a decreased probability of survival. These probabilities at 1 and 5 years postoperatively were 74 and 54%, respectively. Death resulted most often from infection or comorbid conditions. All surgery patients with interstitial lung disease died within 28 months postoperatively. In patients with RA undergoing cervical spine surgery, fatality rates appear to be increased in patients with severe extraarticular manifestations, especially interstitial lung disease.

Actuarial Analysis↗
PubMed1988

Salicylate ototoxicity in patients with rheumatoid arthritis: a controlled study.

Tinnitus or subjective hearing loss, or both, were reported by 61 of 134 (45%) patients with rheumatoid arthritis (RA) taking regular salicylates and by 73 of 182 (40%) untreated healthy subjects. In the patients with RA mean salicylate levels were not higher in those with tinnitus than in those without tinnitus, but levels were significantly higher in those with subjective hearing loss than in those with no symptoms. Twenty five per cent of the patients with RA had tinnitus or subjective hearing loss with salicylate levels less than 1.42 mmol/l. Audiometric responses in 31 patients correlated poorly with symptoms. Tinnitus and subjective hearing loss may be too non-specific to be reliable as tools for adjusting the salicylate level into the therapeutic range.

Adult↗
PubMed1988

Involvement of the craniocervical junction in Reiter's syndrome.

Although Reiter's syndrome uncommonly affects the cervical spine, involvement of the craniocervical articulations does occur and may be manifested as nonreducible rotational head tilt. Computerized axial tomography with reformatted images was helpful in assessing the anatomy of this area in our patient with significant head tilt and abnormal head position.

Adult↗
PubMed1987

Atlantoaxial (C1-C2) facet joint osteoarthritis: a distinctive clinical syndrome.

Osteoarthritis of the atlantoaxial facet joints was identified radiologically in 27 patients, and these comprised 4% of all outpatients with osteoarthritis or degenerative disease of the spine seen during a 36-month period. These patients had a clinical syndrome which differed from those seen in patients who have subaxial degenerative disease of the spine or myofascial cervical pain. Occipital pain, occipital trigger points, crepitus in the occipital region, and a rotational head tilt deformity (in 13 patients, usually associated with collapse of 1 of the lateral masses [facets]), were the major features of this distinctive syndrome.

Atlanto-Axial Joint↗
PubMed1987

The nature of the onset of rheumatoid arthritis: a reassessment.

A total of 300 consecutive patients referred to a tertiary-care center and fulfilling the American Rheumatism Association criteria for definite-classical rheumatoid arthritis, (with a mean disease-duration of 10.3 +/- 9 years) were studied by structured interview and medical record review. The type of onset (rapid or insidious), type of joint involved (small, medium, large or combined joints) and pattern of joint involvement (monarticular, pauciarticular or polyarticular) at onset, and the interval between the first symptom and development of established disease were determined from the interview (based on the patient's memory). The onset was rapid in 46%. Initial involvement occurred in small joints in 31%, medium joints in 16%, large joints in 28% and combined sites in 25%. The pattern of joint involvement at onset was monarticular in 21%, pauciarticular in 44% and polyarticular in 35%. The time for disease to become established was less than 1 month in 25%, 1-6 months in 35%, 6-12 months in 14% and over 1 year in 26%. The monarticular pattern of onset was associated with slower development of established disease than the other patterns of joint involvement; polyarticular disease tended to be associated with polyarticular onset; involvement of large joints was associated with pauciarticular onset.

Arthritis, Rheumatoid↗
PubMed1987

Acute non-infectious arthritis of the hip in patients with rheumatoid arthritis.

Five patients with rheumatoid arthritis and no previous hip joint disease developed an acute disabling arthritis in one hip joint. Roentgenograms were negative and synovial fluid from the hip joint was inflammatory, but no crystals were seen and cultures were negative. Four of the five patients responded rapidly to intra-articular corticosteroids, and none of the five has had further hip joint symptoms during a mean follow up period of two years.

Acute Disease↗
PubMed1987

Monoarthritis as the presenting manifestation of localized Ewing's sarcoma in an older patient.

Monoarthritis, infrequently recognized as a manifestation of primary malignant disease of the bone, is rarely associated with Ewing's sarcoma. Our patient presented with knee monoarthritis, and histology established the diagnosis of Ewing's sarcoma. His disease apparently remitted with chemotherapy but recurred in multiple sites one year later, and repeat chemotherapy failed to produce a remission.

Adult↗
PubMed1986

Small joint involvement: a systematic roentgenographic study in rheumatoid arthritis.

Standard hand and foot roentgenograms from 200 consecutively hospitalised patients with definite or classical rheumatoid arthritis (RA) were read for marginal erosions by three independent observers. For each joint or group of joints analysed the degree of symmetry (S = absolute symmetry, U = unilateral, PS = partial symmetry) was determined. The total number of joints affected significantly correlated only with disease duration; symmetry of erosions and number of affected patients were not influenced by seropositivity. Metatarsophalangeal erosions (in 70%) were the most common and were classified as S in 16%, U in 21%, and PS in 63%. Metacarpophalangeal erosions (in 68%) were also common, with a symmetry pattern of S in 19%, U in 21%, and PS in 60%. Proximal finger interphalangeal erosions (in 42%) were unilateral in 42% (S in 8% and PS in 50%). The only site where symmetry was usual (90%) was the wrist, but radiocarpal and intercarpal joints were considered together. Erosions also occurred in about 16% of the finger distal interphalangeal and 28% of the great toe interphalangeal joints. In RA roentgenographic asymmetry is usual and unilateral involvement common.

Adult↗
PubMed1984

Rheumatoid myositis. Clinical and histologic features and possible pathogenesis.

Thirty-one patients with rheumatoid arthritis were consecutively studied for evidence of muscle involvement, using muscle biopsy and electromyography. The patients were initially separated into 4 clinical categories: inactive peripheral joint disease (6 patients); active peripheral joint disease (10 patients); systemic disease and a disproportionately elevated sedimentation rate for the degree of mild synovitis (SERD) (11 patients); or elevated creatinine phosphokinase level (4 patients). In addition to routine histology, muscle tissue was examined for de novo synthesis of IgM and IgM rheumatoid factor, and by indirect immunofluorescence for the presence of immunoglobulin and complement deposits. Our results indicate that: muscle fiber necrosis occurs frequently in patients with rheumatoid arthritis; rheumatoid myositis, defined as muscle fiber necrosis and mononuclear cell infiltration, is a distinct entity and occurs particularly in patients with SERD or an elevated creatinine phosphokinase level; and only muscle from patients with rheumatoid myositis exhibited de novo synthesis of rheumatoid factor and significant quantities of IgM, indicating that local immune events may be important in the pathogenesis of this entity.

Arthritis, Rheumatoid↗