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Biomedical subjects

K Tallroth

Publications and source records attributed to K Tallroth.

At least 19 recordsLinked to original sources
PubMed1992

Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up.

A randomized, placebo-controlled, double-blind, crossover study in 40 lumbar spinal stenosis patients with a 1-year follow-up showed that calcitonin had beneficial effects on the patients' symptoms without producing any notable side effects. Calcitonin had a clear analgesic effect. The mean of walking distance increased, but the crossover trend was not as good as the analgesic effect. Side effects such as erythema and nausea were usually mild and transient. Calcitonin therapy can be used as a conservative treatment in selected cases of lumbar spinal stenosis. When rest pain was mild or the walking distance was under 200-300 m because of neurogenic claudication, the effect of calcitonin seemed to be poor.

Adult↗
PubMed1992

Lumbar mobility in asymptomatic individuals.

A radiological study of angulatory and translational lumbar mobility and of lumbar scoliosis was performed on 56 persons aged 35-54 years who had no history of back pain. The measurements of mobility were based on extension-flexion views; the assessment of scoliosis was done using radiographs taken in the standing position. The results indicated that the largest range of angulatory motion occurred in the L5-S1 segment (mean, 17.3 degrees for women and 16.4 degrees for men). Five-millimeter translational motion was so common in the L3-L4 and L4-L5 segments, as was 4-mm in the L5-S1 segments, that these values cannot be considered with certainty as pathological. Ten subjects (18%) showed scoliosis of > or = 10 degrees. Although based on a small series, these results are a step toward a more objective and careful interpretation of extension-flexion and functional radiographs of low-back pain patients.

Adult↗
PubMed1991

Metaphyseal sclerosis in patients with chronic renal failure.

We reviewed radiographs of the hands and wrists of 33 patients with immature skeletons and chronic renal disease. Various radiographic manifestations of renal osteodystrophy were seen, including osteopenia in 23 patients (70%), subperiosteal resorption in 20 (61%), distal tuft resorption in 14 (42%), sclerosis of vertebral bodies in 2 (6%), and soft-tissue calcification in 1 (3%). We also noted that 13 patients (39%) exhibited metaphyseal sclerosis adjacent to the growth plates. Five of these 13 showed persistent sclerosis years after the growth plates had fused. None of the patients showed other radiographic changes of rickets, and there was no correlation between the serum calcium, phosphorus, or aluminum levels and the presence of metaphyseal sclerosis. Neither was there any association with the underlying cause of renal failure, method of treatment, presence of a transplant, or type of dialysis. We view this finding as another manifestation of renal osteodystrophy. The importance of distinguishing it from other sclerotic lesions is discussed.

Adolescent↗
PubMed1991

Disc degeneration and angular movement of the lumbar spine: comparative study using plain and flexion-extension radiography and discography.

A study was made of the association between disc degeneration observed in plain radiographs, in discograms (Adams' classification), and instability expressed as abnormal angular movement of lumbar vertebrae. The series included 169 discs in 77 consecutive patients (42 men, 35 women) whose mean age was 34 (range 16-46) years. Discography was more sensitive than plain radiography in the diagnosis of disc degeneration was more common in men than in women (Chi square test, chi 2 = 9.88, p less than 0.05). An increase in disc degeneration was observed in lower lumbar segments (Chi square test, chi 2 = 48.63 p less than 0.001). However, no association between abnormal angular movement and discogram type was observed (Chi square test, chi 2 = 2.63, p less than 0.05). It seems that disc degeneration seldom results in abnormal angular movement and instability of the lumbar spine. Therefore, flexion-extension radiography may only have limited diagnostic value.

Adolescent↗
PubMed1991

Progression of spondylolisthesis in children and adolescents. A long-term follow-up of 272 patients.

The radiologic progression of spondylolisthesis during a long-term follow-up was studied in 272 children and adolescents. There were 134 girls and 138 boys. The mean age at the first visit was 14.3 years (girls, 13.8 years; boys, 14.9 years). The radiologic follow-up time was 14.8 years on average (range, 5-32). The operation was done in 190 patients younger than 20 years of age. Fusion in situ, using a posterior or posterolateral technique, had no statistically significant effect on progression. Surgically treated patients did not differ from conservatively treated patients. Ninety percent of the slip, on average, had already occurred at the first radiologic examination compared with the final amount of slip. More than 10% progression occurred in 62 patients, mainly within the first year postoperatively or after the first examination. Progression of the lumbosacral kyphosis and sinking of the vertebral body was noted in severe slips. Although female gender and dysplasia (spina bifida) at the lumbosacral junction were more frequent in severe slips, they statistically had no value in predicting progression. A wedge form of L5 or sacral rounding also had no prognostic value. These were secondary to the slip and expressed it but did not predict it. The only radiologic variable with predictive value of progression was the percentage amount of the primary slip. In age groups corresponding to the growth spurt in early puberty (girls, 9-12 years; boys, 11-14 years), there was a tendency to progress.

Adolescent↗
PubMed1991

Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable.

Leg-length inequality was measured from radiographs at the level of the vertices of the femoral heads in 247 men and women aged 35-54 years. Of these, 53 had never had any low-back problem, but they had considerable variation in leg-length inequality (mean SD, 5.5 +/- 4.1 mm; range, up to 20 mm). This group of symptom-free individuals did not differ from a group of 78 persons who had disabling low-back pain (LBP) during the previous 12 months (mean SD, 5.3 +/- 4.0 mm; range, up to 17 mm). The adjusted relative risks (odds ratios) of having LBP ever and of disabling pain during the last 12 months were 0.78 (95% confidence interval, 0.43-1.17) and 1.02 (0.68-1.38), respectively, for an increase of 5 mm in leg-length inequality. The results from this study make an association between mild leg-length inequality and LBP questionable.

Adult↗
PubMed1991

Leg length inequality in total hip replacement.

Clinical and radiographic leg length inequality and pelvic tilt were measured in the erect posture in 36 patients before and after total hip replacement. Good correlation was observed between clinical and radiographic evaluations of pelvic tilt, assessed as height difference between iliac crests. Intraoperative alteration of leg length correlated well with changes in pelvic tilt but not with changes in true radiographic leg length inequality. It is suggested that adjustment of leg length during total hip arthroplasty should aim at correction of preoperative pelvic tilt observed during clinical and radiographic examination. True leg length, assessed as the height of the vertex of the femoral or prosthetic head is misleading. It does not reveal functional leg length, which is determined not only by the true leg length but also by the position of the hip joint on the pelvic wall.

Adult↗
PubMed1991

Premedication and short term complications in iohexol discography.

In 52 patients 0.5-3.0 ml of iohexol, 180 mg/ml, was injected using lateral injection technique and fluoroscopy control. A total of 146 lumbar discs using local anaesthesia was injected. Two types of premedication were used; either diazepam alone or diazepam in combination with pethidine and glycopyrronium bromide. There was no difference in the discography injection pain between the groups (X2 = 0.774, P greater than 0.05]. During discography, some patients had nausea (2%), convulsions (4%), back pain (6%) and hypotension (10%), but no allergic reactions were seen. This suggests that these immediate reactions are more related to the procedure itself than to the non-ionic ratio 3.0 iohexol contrast medium. More troublesome iatrogenic complications were seen the day after the discography in the form of severe headache (10%) probably related to liquor leakage, and increasing low back pain (81%). The latter may be caused by local haematoma or chemical irritation from iohexol. Patients with no pain during injection had a relatively slight need for analgesics (Somer's D = -0.196, P less than 0.05).

Adult↗
PubMed1990

Spinal stenosis subsequent to juvenile lumbar osteochondrosis.

This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly narrowed, a diagnostic sign of central spinal stenosis. Therefore, myelography should always be contemplated when osteochondrous changes are present and spinal stenosis is suspected clinically regardless of whether the spinal canal diameters are normal in plain films.

Adult↗
PubMed1990

Revision of aggressive granulomatous lesions in hip arthroplasty.

Fourteen patients had revision arthroplasty for aggressive granulomatosis in 16 previously replaced cemented total hips. The revision was performed on average 8 years (range, 6-13 years) after the primary arthroplasty. Twelve patients had multifocal granulomatous lesions. Pain was the first clinical sign of the aggressive granulomatosis, beginning on average 1.7 years (range, 0.8-3.8 years) after the primary operation. One patient had a fracture of the femur due to large granulomas while waiting for revision. The patients were under follow-up evaluation for an average of 5.4 years (range, 4-7 years) after revision. Two patients had recurrence of aggressive granulomatosis at the original sites 4.5 and 6.5 years after revision. Eleven patients had good or excellent results of revision.

Aged↗
PubMed1990

Extension-flexion radiographs for motion studies of the lumbar spine. A comparison of two methods.

Since abnormal motion is a quantitative phenomenon and present primarily in the two lowest vertebral spaces, a roentgen examination method yielding the maximum mobility would appear to be suitable. When performing extension-flexion radiographs of the lumbar spine, positioning of patients varies considerably. The present study describes a new examination method, yielding better mobility of the spine than any method earlier described. For the two lowest vertebral spaces, L4-5 and L5-S1, the new method implied significantly greater angular mobility and total angular mobility between L2-S1 than a previous method. Intra- and interobserver errors accounted for were acceptable and the accuracy of the measurements sufficient for clinical work.

Adult↗
PubMed1990

Cementless revision of aggressive granulomatous lesions in hip replacements.

In 16 patients we used uncemented Lord prostheses at revision operations for aggressive granulomatosis after cemented hip arthroplasties; in 12 bone grafts also were used. In 13 hips the granulomatous lesions were multifocal, and in one the acetabular component was involved. There was no evidence of infection in any case: all the patients had normal ESR and CRP levels. The revision operation was performed on average 9.4 years after the primary replacement; the mean age at revision was 64 years. On radiographs, the bone around the prosthesis had consolidated by an average of 16 months. At follow-up, two to six years later (mean 3.5 years) there had been no recurrences, nine patients had an excellent Mayo hip score, five were good and two fair.

Adult↗
PubMed1990

Clinical relevance of discography combined with CT scanning. A study of 100 patients.

Two different classifications of discograms have been used in a prospective study of 279 injected discs in 100 patients. The five-stage classification of Adams, Dolan and Hutton (1986) showed increased degeneration in the lower lumbar discs and more degenerative changes in men than in women. Exact reproduction of the patient's pain on injection was more common in fissured or ruptured discs than in less degenerate discs, with 81% sensitivity and 64% specificity of the discogram for pain. The additional information obtained by comparing computerised tomography (CT) with discograms was minimal. Discography was found to be useful in the evaluation of chronic low back pain in patients whose ordinary CT scans, myelograms and flexion-extension radiographs were normal. In spondylolysis and spondylolisthesis, discography can disclose whether fusion needs to be extended above the lytic level, and it may show if the pain in patients who have had posterolateral fusion is discogenic. Thus, discography gives information which is useful in deciding whether to operate on patients with chronic low back pain.

Adolescent↗
PubMed1990

Aggressive granulomatous lesions in cementless total hip arthroplasty.

We describe six patients with aggressive granulomatous lesions around cementless total hip prostheses. Two patients previously had a cemented prosthesis in the same hip. The Lord prosthesis was used in five patients, the PCA in one. Both prostheses were made of chrome-cobalt alloy. Pain on weight-bearing occurred on average 3.2 years after the cementless arthroplasty, and at that time radiography revealed aggressive granulomatosis around the proximal femoral stem and the acetabular component in five of the patients; one had a large solitary granuloma in the proximal femur. Revision was performed on average 4.8 years after the cementless arthroplasty. At that time all granulomas had grown large in size; while waiting for revision operation, two femoral stem components fractured. All the granulomas showed a uniform histopathology, which included histiocytosis; the cause for these lesions was thought to be plastic debris from the acetabular socket.

Acetabulum↗
PubMed1990

Aggressive granulomatous lesions associated with hip arthroplasty. Immunopathological studies.

The local immunopathological response was analyzed in six patients who had a revision of a total hip prosthesis because of an aggressive granulomatous lesion and in six patients who had a revision because of common loosening of the prosthetic stem. All twelve patients had had a total replacement arthroplasty for primary osteoarthrosis. All of the prostheses had been cemented. The aggressive granulomas consisted of well organized connective tissue containing histiocytic-monocytic and fibroblastic reactive zones. The granulomas were highly vascularized, and villous structures were observed at many sites. In contrast, the areas around the loose cemented stems were characterized by dense connective tissue. Immunohistological evaluation revealed that most of the cells in the aggressive granulomatous tissue were multinucleated giant cells and C3bi-receptor and nonspecific esterase-positive monocyte-macrophages. This cytological finding suggests a foreign-body-type reaction, compatible with the rapidly progressive lytic nature of the lesion that was shown radiographically. There was a clear-cut difference between aggressive granulomatosis and the more common lesion accompanying prosthetic loosening--namely, the relative lack of activated fibroblasts in granulomatosis. We suggest that granulomatosis involves an uncoupling of the normal sequence of monocyte-macrophage-mediated clearance of foreign material and tissue debris that is normally followed by fibroblast-mediated synthesis and remodeling of the extracellular matrix. We also suggest that aggressive granulomatosis in association with a cemented hip prosthesis is a distinct entity, not only clinically and radiographically, but also histopathologically.

Aged↗
PubMed1990

[Myelography, computerized tomography and electromyography in intervertebral disk diseases of the lumbar spine].

Fifty-five patients who underwent lower spine surgery were preoperatively evaluated with myelography and postmyelography CT. ENMG was done on 23 patients. CT had the highest accuracy in finding the affected level (F = 75,5; p less than 0,0005) as compared to myelography (F = 46,5; p less than 0,0005) or to ENMG (F = 11,4; p greater than 0,15). We did not find statistical differences in diagnostic accuracy in different disc spaces nor was there a difference between primary and recurrent low-back disease.

Adult↗
PubMed1990

Measurement variations in scoliotic angle, vertebral rotation, vertebral body height, and intervertebral disc space height.

Thirty consecutive posteroanterior and lateral radiographs of patients with adolescent idiopathic scoliosis with a mean Cobb angle of 24.4 degrees were read. In measuring the scoliotic angle, the interobserver error (SD) was 2.8 degrees and the intraobserver, 1.8 degrees. Rotation of the apical vertebra was estimated by measuring the translation of the pedicle on posteroanterior radiographs. For vertebral rotation, the interobserver measurement error (SD) was 3.4 and the intraobserver, 1.8%. The height of the apical vertebral body and the intervertebral disc space next inferior to it were measured on lateral radiographs as the anterior angles of the diagonals of the respective body or disc space. In measuring the vertebral body height, the interobserver error (SD) was 3.2 and the intraobserver, 2.6 degrees, and in measuring the intervertebral disc space height, the interobserver error was 2.4 and the intraobserver, 1.8 degrees. The angles can be transformed to a corresponding height/length ratio by a simple trigonometrical formula.

Adolescent↗