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Biomedical subjects

L A Gilula

Publications and source records attributed to L A Gilula.

At least 73 records · Page 4Linked to original sources
PubMed1995

Three-compartment wrist arthrography: direct comparison of digital subtraction with nonsubtraction images.

PURPOSE: To determine the diagnostic value of digital subtraction and fluoroscopic spot images in wrist arthrography, alone and in combination. MATERIALS AND METHODS: Randomized selective bilateral three-compartment wrist arthrography was performed in 64 patients. The fluoroscopic spot and digital subtraction images were read separately by two radiologists without knowledge of the clinical data. RESULTS: One hundred twenty communicating defects were found in 69 wrists in 42 patients. Fluoroscopic spot radiographs alone depicted defects in all 69 wrists, but precise localization was not possible in 10 defects. Subtraction images alone demonstrated 59 defects. The defects not seen with digital subtraction imaging were identified after wrist motion. Digital subtraction images demonstrated defects earlier during the joint injection and demonstrated the exact site of the 10 defects not localized on the nonsubtracted images. CONCLUSION: Digital subtraction and fluoroscopic spot images are complementary in wrist arthrography and, when used in combination, increase the ability to localize the sites of defects, although the value added by the subtraction technique is small.

Adolescent↗
PubMed1995

Spatial dysmorphology of the foot in Apert syndrome: three-dimensional computed tomography.

Computer assisted medical imaging was used to define the spatial dysmorphology of the foot in three patients with Apert syndrome and to correlate that dysmorphology with ambulation and footwear. Thin slice (2 mm), abutting, high resolution axial computed tomography (CT) foot scans were obtained. The CT data were post processed, using Analyze, to generate three-dimensional surface shaded and volumetric reformations. The reformatted images were evaluated by a bone and joint radiologist to identify abnormalities of bone shape, size, and orientation, of joint morphology, and of the foot as a whole. Five consistent findings were observed among the three pairs of feet: (1) anomalous great toes with phalangeal and metatarsal pathology; (2) simple syndactyly of toes 2-5; (3) fusions between matatarsals; (4) tarsal coalitions; and (5) limitations in commercial footwear. One patient underwent bilateral fifth metatarsal wedge osteotomies to facilitate the wearing of shoes. The dysmorphology of the Apert foot is a combination of congenital malformations and postnatal deformations, secondary to progressive synostosis. Prophylactic foot surgery may be indicated in Apert patients to facilitate shoe fitting.

Acrocephalosyndactylia↗
PubMed1995

A 28-year-old woman with swelling of the thumb.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. The initial history, physical findings, and roentgenographic examinations are found on this page. The clinical and roentgenographic diagnoses are presented on the following pages.

Adult↗
PubMed1995

A 13-year-old boy with rapidly progressive spinal deformity.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Adolescent↗
PubMed1995

Giant-cell tumor of the distal phalanx of the hand in a child.

Giant-cell tumor of bone in the distal phalanx is rare, as is its clinical occurrence in children. A case of a 10-year-old girl with giant-cell tumor in the distal phalanx of the left thumb is reported, and a literature review of phalangeal giant-cell tumor of the hand is presented. The tumor was curetted, and after 2.5 years there was no recurrence.

Bone Neoplasms↗
PubMed1995

A 32-year-old woman with pain and swelling at the base of her thumb.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Adult↗
PubMed1995

A 9-year-old girl with swelling and pain in the leg.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are presented on this page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Bone Neoplasms↗
PubMed1995

A 55-year-old man with bilateral lower-limb numbness and weakness.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to orthopedic surgeons. The initial history, physical findings, and roentgenographic examinations appear on this page. The clinical and roentgenographic diagnoses are presented on the following pages.

Cauda Equina↗
PubMed1995

A 7-year-old girl with a growth disturbance in the extremities.

The following case describes the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on this page. The final clinical and roentgenographic differential diagnosis can be found on the pages that follow.

Child↗
PubMed1995

A 9-year-old girl with a bowed right forearm 6 months after a fracture.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Cafe-au-Lait Spots↗
PubMed1994

Os centrale carpi simulating a scaphoid waist fracture.

The os centrale carpi is a relatively rare accessory carpal bone, and its presence may be confused with a scaphoid fracture. A case is presented which simulated an un-united scaphoid fracture on the plain X-ray film. However, CT in the sagittal plane showed two rounded fragments on the dorsum of the scaphoid with smooth, regular cortical margins differing from an acute scaphoid fracture. Their volume combined with the volume of the scaphoid is more than that of a completely normal scaphoid. There is no evidence of degeneration in the two rounded fragments and scaphoid. Because of these features, the diagnosis of soft tissue injury with an incidental finding of an os centrale carpi was suggested.

Aged↗
PubMed1994

Computed tomography scanning with image reconstruction in evaluation of distal radius fractures.

Seventeen patients with 18 intraarticular distal radius fractures underwent computed tomography (CT) scanning and image reconstruction to evaluate their distal radius fractures. All patients were selected prospectively because of intraarticular extension and/or displacement of their fractures on pre- or post reduction plain films. Patients who were not surgical candidates for open reduction and internal fixation of their fracture were not included in the study. X-ray films and CT scans were viewed separately and in random order by a senior radiologist not familiar with the cases. Both x-ray films and CT scans readily showed extension of fracture lines into the radiocarpal joint, radial shaft, and the ulnar styloid, but CT scans were better than x-ray films at demonstrating fracture involvement of the distal radioulnar joint, the extent of articular surface depression, and the amount of comminution. Due to the cost, it is recommended that the test only be used for patients who are surgical candidates for open reduction and internal fixation or when more information about the extent of comminution and joint depression is required.

Adolescent↗
PubMed1994

Prognostic features of Ewing's sarcoma on radionuclide bone scan after initial treatment.

OBJECTIVE: To study short-term changes in the radiopharmaceutical bone scan (BS) appearance of Ewing's sarcoma for indicators of decreased survival or future disease progression. METHODS: One-hundred and four patients with non-metastatic Ewing's sarcoma were evaluated at three time points: time of diagnosis (pre-biopsy), after induction chemotherapy (13 weeks) and after radiation therapy (20 weeks). Radiographs, computed tomograms (CTs) and BSs were obtained at each interval. Primary lesion activity and size on BS were evaluated and compared to radiographic and CT findings. RESULTS: No significant relationship was found at any time point between absolute radiopharmaceutical activity within the primary lesion and either disease progression or patient survival. Relative changes in BS activity between time points were also not significantly related to disease progression or survival despite a significant decrease in activity among the three time points. The size of the BS abnormality compared to the CT abnormality at the primary lesion site was related to both survival and disease progression at the post-induction chemotherapy time point (P = 0.025 and P = 0.014, respectively) with larger BS abnormalities indicating worse prognosis and survival. This relationship lost its significance at the post-radiation time point. No other significant relationship between the relative size of the BS abnormality and the size of the plain radiographic or CT abnormality was detected. CONCLUSION: Our data suggest that BS imaging of the primary lesion of Ewing's sarcoma provides little information in terms of predicting long-term survival or disease progression in patients with non-metastatic Ewing's sarcoma.

Adolescent↗
PubMed1994

Wrist instability series: increased yield with clinical-radiologic screening criteria.

PURPOSE: To develop screening criteria for patients with wrist pain who have carpal instability. MATERIALS AND METHODS: Data were accumulated retrospectively from the cases of 535 patients with painful wrists (321 male and 214 female patients, aged 11-71 years), who underwent wrist arthrography and wrist instability series between 1979 and 1990. Four screening criteria were evaluated: abnormal carpal alignment on routine radiographs, scapholunate joint or ligament pain, reproducible painful clicking or popping, and positive capitolunate instability pattern. Patients with one or more criteria were assigned to group 1. Patients without any of the criteria were assigned to group 2. RESULTS: Group 1 comprised 142 patients (27%) and group 2 comprised 393 patients (73%). In group 1, 69 (49%) patients had abnormal wrist instability findings, and in group 2, nine (2%) had such findings. All abnormalities in group 2 were depicted on routine arthrograms. CONCLUSION: With use of these screening criteria, the majority of patients with wrist pain do not need to undergo wrist instability series and those that do can undergo a specially tailored series.

Adolescent↗
PubMed1994

Endemic fluorosis of the skeleton: radiographic features in 127 patients.

OBJECTIVE: A wide range of radiographic appearances have been reported in skeletal fluorosis, but little has been written about the spectrum of radiographic features. We evaluated the spectrum of radiographic appearances in this disorder to help with its diagnosis and differentiation from other metabolic skeletal disorders. MATERIALS AND METHODS: One hundred twenty-seven patients with clinically proved endemic fluorosis had radiographs of the chest, spine, pelvis, elbow, forearm, and knee obtained. The radiographic findings were classified as osteosclerosis, osteopenia, intermittent growth lines, diaphyseal widening, or soft-tissue ossification. Two different osteopenic patterns were defined: an osteoporotic pattern with overall decreased bone density and an osteomalacic pattern that combines the features of osteoporosis with bone deformity. Soft-tissue ossification included involvement of ligaments, tendons, and interosseous membranes. RESULTS: Ninety-eight of the patients (89% of the adults) had some evidence of calcification and/or ossification of the attachments of ligaments, tendons, muscles, and interosseous membranes. Osteosclerosis was seen in 54 patients (43%), and osteopenia was seen in 51 patients (40%). Of the patients with osteopenia, the osteoporotic pattern was seen in 28 and the osteomalacic pattern in 23. Growth lines were found in 89 patients (70%). Metaphyseal osteomalacic zones were found in children. Diaphyseal widening was present in 35 patients (28%). CONCLUSION: Endemic skeletal fluorosis can have a wide variety of radiographic appearances, including calcification and/or ossification of the attachments of soft-tissue structures to bone, osteosclerosis, osteopenia, growth lines, and metaphyseal osteomalacic zones.

Adolescent↗