Search PubMed⌕ Search

Biomedical subjects

L A Gilula

Publications and source records attributed to L A Gilula.

At least 163 records · Page 9Linked to original sources
PubMed1988

Role of radionuclide imaging in the evaluation of wrist pain.

The cause of hand and wrist pain can be difficult to determine, especially when standard radiographs are normal or show only nonspecific changes. This study reports the effectiveness of radionuclide imaging in the evaluation of patients with hand and wrist pain of uncertain cause. Eighty-eight patients with hand and wrist pain and initially normal standard radiographs were evaluated prospectively by additional radiographic methods including the following: routine tomography, wrist arthrography, computerized tomography, or magnetic resonance imaging. Each patient also had bone scintigraphy. The diagnosis established by clinical assessment and by other imaging methods was then compared with the scintigraphic findings. The presence or absence of focal scintigraphic abnormalities correlated with the presence or absence of focal pathology definable by the conventional methods in 88% of patients. As expected, scintigraphy was chiefly of value in defining the locus of an injury or other process in the wrist, rather than the nature of an abnormality. The scintigrams were abnormal in 95% of cases involving complete intrinsic ligament ruptures and fractures and were normal in 96% of patients with no definable injury. Scintigraphic findings correlated poorly with partial intrinsic ligament injuries and in cases of synovitis. Radionuclide imaging is a sensitive means of detecting focal lesions in patients with hand and wrist pain of unknown cause.

Adult↗
PubMed1988

Arthrographic surface anatomy of the carpal triangular fibrocartilage complex.

In a review of 364 radiocarpal and 123 distal radioulnar joint arthrograms we identified 44 (12%) patients with contrast defects at either the proximal or distal surface of the carpal triangular fibrocartilage complex (TFCC). Differences in their arthrographic characteristics distinguished two separate groups of patients; one with similar and another with dissimilar appearing TFCC surface contrast collections. Thirty-one of our 44 patients had similar appearing, isolated radial-sided collections at either the proximal or distal TFCC surfaces. Our arthrographic, demographic, and historical study of these patients suggests that the collections are not caused by traumatic partial TFCC tears but represent a normal anatomic variant, probably a synovial recess at the radial TFCC attachment. Arthrography and dissection of a limited number of cadaveric specimens confirmed this conclusion. The second group included the remaining 13 patients. This group had contrast collections at either the proximal or distal TFCC surface, which varied in location and appearance. This smaller group is more likely to represent those uncommon patients with partial TFCC defects caused by tears.

Adolescent↗
PubMed1988

Fracture of the dorsoulnar tubercle of the trapezium.

The dorsoulnar tubercle of the trapezium may fracture, and this fracture may be missed without precise physical examination and correct radiographic studies. If there is persistent localized pain and tenderness in this region and the results of routine wrist radiographic examination are normal, a bone scan should be performed. If there is localized uptake in the area of the trapezium, additional radiographic studies may be necessary to confirm or exclude this fracture. Four patients with this previously unreported fracture and a method for its detection are presented.

Adult↗
PubMed1988

Radiologic and pathologic patterns of end-plate-based vertebral sclerosis.

Degenerative spondyloarthropathy is the result of a number of related pathologic processes, including loss of disc elasticity, repetitive mild trauma, and osteoporosis. The effects are manifested microscopically in a number of patterns reflecting alterations in stress, healing microfractures, and bone-cartilage interactions along the vertebral end-plate. The microscopic changes lead in turn to radiographically evident vertebral body sclerosis. The resultant sclerosis is not always in the classic band-like pattern along the vertebral end-plate, and the atypical patterns may be difficult to recognize as degenerative in origin. In a detailed analysis of clinical and postmortem material, we have categorized both the pathologic and radiographic patterns of benign non-Pagetic vertebral body sclerosis. This radiographic classification provides a unified framework for clinical recognition of the various patterns of degenerative sclerosis.

Adult↗
PubMed1988

Roentgen rounds #94. Osteomyelitis of the left ilium--left iliacus muscle abscess.

A left iliac osteomyelitis and left iliacus muscle abscess occurred in a patient who underwent bipolar hemiarthroplasty of the left hip six months prior for avascular necrosis of the left femoral head, secondary to sickle-cell disease. This illness followed an upper respiratory tract infection, and her physical examination was suggestive of a septic process involving the left hip. An aspirate of the hip was not confirmative for septic arthritis. The plain roentgenograms demonstrated that the prosthesis was in an acceptable position, but had limited value in the remainder of the differential diagnosis. In this case, the bone scan contributed significant information distinguishing osteomyelitis from osteonecrosis. The CT scan allowed rapid localization of an occult abscess and destructive changes in the left ilium secondary to osteomyelitis and guided surgical treatment.

Abscess↗
PubMed1987

Primary Ewing's sarcoma involving the bones of the head and neck.

Ewing's sarcoma is a rare tumor of the bone. In the Intergroup Ewing's Sarcoma Study (IESS) approximately 4% of the primary bone tumors arose in the bones of the head and neck. The mean age of patients was 10.9 years; boys slightly dominated the group. Signs and symptoms were local in distribution, with a mass or swelling most frequent. As in other sites, we categorized the dominant histologic pattern as diffuse or filigree, the latter carrying a more unfavorable prognosis. The radiographic appearance may be atypical as compared to Ewing's sarcoma at other sites. Prognosis of head and neck Ewing's is significantly better than Ewing's sarcoma overall. The gnathic bones were commonly affected, yet there was no associated mortality. No patient with primary disease in the bones of the head and neck who survived for 5 years on any of the IESS protocols has subsequently died.

Adolescent↗
PubMed1987

Distal phalangeal brachydactyly secondary to healed renal osteodystrophy.

Six cases of distal phalangeal brachydactyly of the hands in patients with healed renal osteodystrophy are reported. Severe osseous changes of renal osteodystrophy were seen in all cases. These cases present healed renal osteodystrophy as another consideration in the differential diagnosis of distal phalangeal brachydactyly.

Adult↗
PubMed1987

Arthrographic evaluation of the carpal triangular fibrocartilage complex.

One hundred sixty-two patients had analyses for correlation of triangular fibrocartilage abnormalities (TFCC), with duration and location of pain and other possible associated radiographic, scintigraphic, and arthrographic abnormalities. Results indicated that TFCC perforations did not correlate with any pain complex or other associated radiographic, arthrographic, or scintigraphic abnormality. No association with carpal instability or with ulnar variance could be identified. No definition between perforations that were posttraumatic and those that were the results of a degenerative process could be made. Several small defects on both the proximal and distal surfaces of the TFCC were identified. They do not appear to have been reported previously in the literature. Their significance is discussed.

Adult↗
PubMed1987

Posteroanterior wrist radiography: importance of arm positioning.

Proper interpretation of wrist radiography requires a standardized radiographic technique. We obtained posteroanterior (PA) radiographs of the wrist in nine patients in three different arm positions to study the effect of arm position on ulnar styloid process orientation. An appearance simulating a normal anteroposterior (AP) wrist radiograph was present in six of nine PA radiographs when the arm was positioned next to the trunk, and the elbow was flexed to a 90% angle. The orientation of the ulnar styloid was not helpful in differentiating either pronated from supinated wrist positions or AP from PA projections. We concluded that radiographic screening of the carpus should be performed with standardized wrist positioning and nomenclature as described in modern radiographic technological texts. Supplemental projections should be exposed and interpreted with an understanding of the position of the arm and the direction of the incident radiographic beam at the time of examination.

Arm↗
PubMed1987

Wrist: coronal and transaxial CT scanning.

Computed tomography (CT) of the wrist can be useful in selected clinical applications and is generally performed in the transaxial orientation. Coronal and transaxial CT scanning of the wrist were directly compared in three patients and in a normal, isolated cadaveric hand. Twenty other patients with wrist problems who underwent only transaxial or coronal CT examinations were also considered to assess the clinical indications of both techniques. A simple Lucite holder was designed and tested to simplify patient positioning with the coronal CT technique. In most clinical situations, coronal images were superior to transaxial images because the former were more detailed and easier to interpret. In some specific cases, however, especially fracture of the hamate hook and distal radioulnar subluxation, transaxial CT scanning was superior.

Adult↗
PubMed1987

Fluoroscopic identification of torn intercarpal ligaments after injection of contrast material.

Wrist arthrography is often used to evaluate the integrity of the scapholunate and lunotriquetral ligaments. This may be difficult when the ligaments are obscured by contrast material in standard radiographic projections, despite filming under fluoroscopic observation during the injection of contrast material. When superimposition occurs, we recommend fluoroscopic positioning of the wrist to optimally visualize the individual ligaments in profile. We applied this technique in performing 240 wrist arthrograms, 88 (37%) of which had scapholunate and/or lunotriquetral ligament tears. As a result, a definite diagnosis of the specific site of ligamentous disruption was possible in all but one case. Using this technique, we also identified six short-segment or "pinhole" ligamentous tears. Identification of commonly interrupted ligaments in profile by using fluoroscopy after contrast material has been injected may allow identification of specific ligamentous disruptions or short-segment tears, as well as a diagnosis of a specific anatomic abnormality that otherwise would not be possible.

Arthrography↗