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Biomedical subjects

L A Gilula

Publications and source records attributed to L A Gilula.

At least 145 records · Page 8Linked to original sources
PubMed1990

Subtalar arthrosis: evaluation with CT.

The surgical implantation of a Silastic wedge into the lateral subtalar joint (subtalar arthrosis) is designed to restrict the osseous malalignment associated with a flexible or neurogenic flatfoot deformity. We used CT to examine patients who had persistent pain after a subtalar arthrosis and retrospectively reviewed our experience with CT scans of 13 subtalar implants (seven patients) during a 3.5-year period. The CT scans of four asymptomatic subtalar implants showed each implant in the expected position and orientation, and the findings were considered normal. Conversely, the findings on CT scans of all nine painful implants (seven patients) were interpreted as abnormal. The scans showed oblique orientation of four implants (44%), loosening of three implants (33%), extruded methyl methacrylate in the subtalar joint in two implants (22%), and abnormal calcaneal recession in two implants (22%). Five of the nine painful implants were revised with improvement or resolution of symptoms. Our experience suggests that CT scanning of the subtalar joint can show the position and orientation of a subtalar implant and identify causes of persistent pain after a subtalar arthrosis.

Adolescent↗
PubMed1990

Imaging rounds #103. Myositis ossificans in association with congenital radioulnar synostosis and congenital anterior radial head dislocation.

Although the initial trauma was minimal in this unusual case of bilateral congenital radioulnar synostosis and anterior radial head dislocation associated with myositis ossificans, a progressive decrease in elbow ROM ensued. Manipulation under general anesthesia was performed to improve flexion and extension of the involved elbow. This manipulation most likely initiated or enhanced the process of myositis ossificans in the elbow. Final treatment consisted of reassurance and active ROM exercises, with resolution of symptoms.

Adult↗
PubMed1990

Wrist pain: a systematic approach to diagnosis.

Numerous radiographic procedures are now available to help determine the cause of wrist pain. This paper presents a wrist-pain algorithm that defines the relative roles of various radiographic techniques in the evaluation of patients with wrist pain. Practical application of the algorithm is demonstrated through illustrative cases.

Adult↗
PubMed1990

Imaging the symptomatic wrist.

1. Imaging studies are useful adjuncts to clinical evaluation. 2. Conventional radiographs remain the keystone of the imaging evaluation of wrist disorders owing to their broad survey capabilities and cost-effectiveness. 3. CT and MRI are excellent to delineate process extent and to improve lesion characterization. 4. MRI and nuclear medicine provide for greater sensitivity for detection and activity of disease, but at a cost of less specificity and greater expense.

Algorithms↗
PubMed1989

Rigid subtalar joint--a radiographic spectrum.

A painful or rigid subtalar joint is a common clinical problem. Computed tomography (CT) has been shown to be useful in evaluating tarsal coalition, but several other pathologic processes with a similar clinical presentation may affect the subtalar joint. Findings from 45 radiographically abnormal subtalar joints are presented, including examples of three different patterns of subtalar tarsal coalition, arthritis, infection, trauma and postsurgical changes. Knowledge of different causes of subtalar pathology may permit ready explanation of symptomatology related to the subtalar joint.

Humans↗
PubMed1989

Management of chronic lunotriquetral ligament tears.

Treatment of chronic disruptions of the lunotriquetral (LT) ligament is not well-defined. Eleven patients treated by LT fusion with use of a compression screw are reported. The injury frequently resulted from hyperextension of the wrist. Pain on the ulnar side of the wrist, limited motion, and tenderness over the LT joint exacerbated by ballottement were present. Standard radiographs were normal. Arthrography showed the ligamentous tear in all cases. After operation, immobilization was continued until fusion was apparent radiographically. Fusion was achieved in all cases between 2 and 5 months. Four patients were free of pain, four patients had pain only at the extremes of motion, and three patients had persistent pain. Mean wrist motion was as follows (preoperative/postoperative): flexion (53 degrees/45 degrees), extension (60 degrees/49 degrees), radial deviation (17 degrees/21 degrees), and ulnar deviation (25 degrees/18 degrees). Maximum grip strength as a percentage of the uninjured side was 73% preoperatively and 59% postoperatively. LT tears can exist de novo or as part of the ulnar impaction syndrome; a method for differentiation is presented.

Adult↗
PubMed1989

Management of scaphoid fractures: a review and update.

The scaphoid is the most commonly injured carpal bone. Almost half of all bony wrist injuries involve the scaphoid. Treatment is controversial and, when inadequate, can result in a painful nonunion or degenerative radiocarpal arthritis. Fracture of the scaphoid occurs most often in young adult men, with a peak incidence between the ages of 15 and 30 years. The scaphoid is less susceptible to fracture during the phase when it is mostly cartilaginous, thus making scaphoid fracture rare in childhood. In this article, we review current treatment of fracture of the scaphoid and examine controversial topics in its management.

Adolescent↗
PubMed1989

Nipple simulating a breast mass on a mammogram.

On a mediolateral mammogram obtained during routine screening, a mass was noted deep within the breast. However, no mass could be palpated, and additional views showed no mass. Observation of the patient during imaging demonstrated the nipple of the opposite breast was inadvertently projected onto the image. Radiologists should be aware of this cause of pseudotumor of the breast.

Adult↗
PubMed1989

Ascending lower limb phlebography: comparison of ioversol and iothalamate meglumine.

Fifty patients undergoing ascending phlebography of a lower limb were evaluated, in a randomized double-blind fashion, to compare the efficacy, patient tolerance, and safety of two different contrast agents. Ioversol-240 (MP-238), a new nonionic agent, and iothalamate-202 (Conray 43), an established ionic agent, were the contrast agents used. Twenty-five patients were injected with iothalamate and 25 with ioversol. The phlebograms were evaluated for diagnostic quality and the patients for symptoms, with special reference to complaints of heat and pain. No significant difference was demonstrated between the two agents in either examination quality or patient tolerance. No major contrast-related reactions were recorded. We conclude that ioversol-240 appears to be a safe and acceptable alternative to iothalamate-202.

Adult↗
PubMed1989

Imaging rounds #97. Salter II fracture of the proximal tibia.

Proximal tibial physeal injury is extremely rare. It occurs most often in adolescents and is the result of a significant abduction force applied to the lower leg with the foot firmly fixed. Management of this injury follows the same principles as other Salter-Harris epiphyseal plate fractures. Prognosis is generally good, although there is a somewhat higher than anticipated incidence of angulatory and longitudinal deformities of Type I and Type II fractures, much as has been observed in distal femoral physeal fractures. This is probably due to direct injury to the germinal layer of the growth plate with subsequent partial physeal closure.

Adolescent↗