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Biomedical subjects

M Kligman

Publications and source records attributed to M Kligman.

At least 19 recordsLinked to original sources
PubMed2001

The role of computed tomography in cervical spinal injury due to diving.

We studied both the clinical features and computed tomography (CT) findings in 25 patients with a cervical spinal injury related to diving. In all patients the X-rays, including anteroposterior, lateral and open mouth views, were normal. The clinical features included headache, dizziness, without an alteration in the state of consciousness. In 5 patients, the CT spinal scan revealed cervical spinal injury unrecognised on X-ray. In 4 of them, the mechanism of the trauma was a direct injury to the head when it hit the bottom of the pool; in 1 patient, the mechanism was indirect injury transmitted from the stretched hands to the cervical spine. We conclude that the cervical spinal injury caused by diving should be evaluated selectively by CT spinal scan in patients with direct cervical injury, even if the clinical and roentgenographic results appear negative.

Adolescent↗
PubMed2001

Hydroxyapatite-coated total hip replacement in Paget's disease: 20 patients followed for 4-8 years.

20 patients, who had had total hip replacements for symptomatic osteoarthrosis secondary to Paget's disease, were followed for a mean of 6 (4-8) years. Proximal hydroxyapatite-coated stems were implanted in all patients. 12 patients received hydroxyapatite-coated, 2 cemented (Muller type) and 6 cementless cups (Morsher type). The mean Harris hip score was 31 (7-40) points preoperatively and 88 (74-100) postoperatively. The radiographic evaluation revealed good stability and fixation using Engh's criteria. One stem subsided early more than 5 mm and then seemed to stabilize. Our findings support the use of hydroxyapatite total hip implants for patients with this disease and osteoarthrosis.

Aged↗
PubMed2000

The effect of intramedullary bone plug on femoral stem migration of hydroxyapatite-coated hip arthroplasty.

This study investigated the effect of intramedullary corticocancellous bone plug on the fixation and stability of hydroxyapatite-coated femoral stems in total hip arthroplasty (THA). Intramedullary corticocancellous bone plug was used in 30 patients with hydroxyapatite-coated femoral stems (group A) and a consecutive series of 30 patients with hypdroxyapatite-coated stems without bone plug served as the control group (group B). Patients underwent clinical and radiographic follow-up for at least 2 years. The addition of corticocancellous bone plug to the hydroxyapatite-coated stem significantly improved clinical and radiographic results. The mean Harris Hip Score at 3 and 6 months postoperatively was 92 and 94 in group A, and 84 and 87 points in group B (P<.004 and P<.001, respectively). There was no significant difference between groups at 1 year postoperatively and thereafter. The predominant cause for the difference was the thigh pain score, which was reduced at both 3 and 6 months in group A compared to group B (P<.01 and P<.05, respectively). There also were statistical differences between the two groups regarding radiographic signs. The evidence of endosteal bone formation in group A patients was superior at 3 and 6 months (P<.001 and P<.01, respectively). The appearance of a radiolucent line was significant in group B patients at 3 and 6 months (P<.001). Femoral stem migration of 3 mm was noted in three group B patients versus no group A patients (P<.05). These short-term clinical and radiographic results suggest corticocancellous bone plug can provide early pain relief and durable implant fixation, but long-term follow-up should be considered.

Aged↗
PubMed2000

Hydroxyapatite-coated total hip arthroplasty in osteoporotic patients.

A prospective review was performed on 22 osteoporotic patients (rated from 1 to 3 on the Singh Index) with hydroxyapatite-coated total hip replacements. These results were compared with a control group (Singh Index 4 to 6) of 45 patients (48 hips) with respect to clinical and radiographic data. Surgery was performed over a six-year period (1991 to 1996) and the time to follow-up evaluation averaged 5 years (range: 2 to 7 years). All patients, in both groups, were over 65 years old with an average age of 71 and 73 years, respectively. The pre-operative diagnoses and Harris hip scores were also similar for both groups. Clinical evaluation was based on the Harris Hip score and radiographic evaluations using Engh's criteria. There was no significant difference between the final average Harris hip score in the osteoporotic bone group, which was 87 points, and that for the control group, which was 91 points (p > 0.05). Radiographic evaluation demonstrated confirmed bone ingrowth in most patients in each group; one patient in each group had suspected bone ingrowth. No stems were revised for aseptic loosening and no endosteal lysis was found. Progressive bone formation was seen around the femoral stem proximally. The acetabular components demonstrated no sign of mechanical loosening or osteolysis. Bone formation was found in most patients in zone I, and in a few patients also in zone III. On the basis of the results of this study, it is believed that osteoporotic bone as a factor by itself should not compromise the early results of hydroxyapatite total hip arthroplasty and should provide good results in the long term.

Aged↗
PubMed1999

Strain differences in neointimal hyperplasia in the rat.

We performed an initial screen of 11 rat strains by use of a standard balloon injury to the left iliac artery to observe whether genetically determined differences existed in the development of neointimal hyperplasia. Neointimal hyperplasia was assayed 8 weeks after the vascular injury on coded microscopic sections. Statistically significant differences in the percentages of the vascular wall cross-sectional areas composed of intima (percentage intima) secondary to neointimal hyperplasia were noted among the different rat strains (P<0.02), with the Brown-Norway (BN), Dark Agouti, and Milan normotensive strain rats having the highest and the spontaneously hypertensive rats (SHR) having the lowest percentages of intima. In a separate experiment, F1 hybrids of SHRxBN strains and parental BN and SHR underwent the vascular injury, and the parental strains again showed a statistically significant difference from one another in the mean percentage of intima (P<0. 0001). The F1 hybrids showed an average percentage of intima intermediate between those of the parental strains. The average lumen size of the injured BN vessels were significantly smaller than that of the noninjured control vessels (P=0.044), but this significance disappeared when the circular areas of these vessels were calculated without taking neointimal growth into consideration (P=0.649). These results provide the groundwork for a genetic linkage analysis to identify the genes that influence the development of neointimal hyperplasia after vascular injury.

Analysis of Variance↗
PubMed1999

Conservative versus surgical treatment for femoral fracture after total or hemiarthroplasty of hip.

This retrospective study compared internal fixation of a femoral fracture following total or hemiarthroplasty of hip with conservative treatment. Sixteen patients were included in the study and classified according to Johannsen. Seven of these patients were treated conservatively by skeletal traction (group A), while the remaining nine patients underwent internal fixation by Mennen plate in conjunction with bone graft (group B). All patients were followed for at least 2 years and evaluated clinically and radiographically using the Mayo Clinic score. The results of group B were superior to those of group A for fracture lines located proximally or extending distally to the tip of the prosthesis. Furthermore, two patients from group A in whom conservative treatment had failed underwent internal fixation, improving their final outcome. Regarding fracture distal to the tip of the prosthesis, there was no significant difference in final outcome between the groups. Our conclusion is that Mennen plate fixation should be considered the treatment of choice in femoral fracture around the tip of a prosthesis, and Mennen plate fixation for fracture distal to the tip should remain as a good option, especially for patients who would like to reduce the length of postoperative hospitalization.

Aged↗
PubMed1999

Cementless coated and noncoated Mathys acetabular cups: radiographic and histologic evaluation.

This study evaluated 185 cementless Mathys coated and uncoated acetabular cups inserted for total hip replacement since September 1984. All of the cups were high-density polyethylene. Sixty were uncoated (group A), 96 were coated with hydroxyapatite (group B), and 29 were coated with titanium (group C). Cup survival was assessed clinically, histologically, and radiographically, and a computer-assisted EBRA method was used to evaluate cup migration. After a mean follow-up of 8 years, five cups in group A that had previously shown migration were revised as a result of aseptic loosening, while no loosening of hip sockets occurred in groups B and C. These results suggest that Mathys cups should be used only if coated with hydroxyapatite or titanium. Furthermore, the histologic evaluation in four cups from groups B and C revealed normal bone formation without inflammation or fibrotic tissue around the cups, promising long-term survival.

Acetabulum↗
PubMed1999

Humeral fracture following shoulder arthroplasty.

Fracture of the humeral shaft after total or hemiarthroplasty of the shoulder occurs infrequently but has serious consequences. This article reports on five patients with ipsilateral humeral fractures following shoulder hemiarthroplasty who were treated either conservatively or surgically. Fractures in the three patients treated conservatively healed on average by 7 months. The results were satisfactory in one patient and unsatisfactory in two patients. Both of these patients complained of pain and limitation of shoulder motion. Fractures in the two patients treated by open reduction and Mennen plate fixation healed on average by 2 months, resulting in a better outcome for these patients treated surgically.

Aged↗
PubMed1998

[Conversion total hip replacement after failed internal fixation of intertrochantric fracture].

Between 1933-1995, 16 patients underwent conversion-total hip replacement after internal fixation of an intertrochanteric fracture failed. Clinical results were unsatisfactory compared to primary total hip replacement. There was a high incidence of intra- and postoperative complications, including femoral fracture, wound infection, and aseptic loosening. This study should increase the surgeon's awareness of the difficulties encountered in conversion of failed intertrochanteric fractures to total hip replacement.

Aged↗
PubMed1998

[Intra-osseous ganglion of scaphoid and lunate bones].

We present a patient with intra-osseous ganglion of the left scaphoid and lunate bones. These were excised and a bone graft inserted. 1 year after operation the patient was free of pain, without limitation of wrist motion. Intra-osseous ganglion of the carpal bone is not common and lunate and scaphoid intra-osseous ganglion has rarely been reported. Awareness of this condition may lead to earlier diagnosis and treatment, with satisfactory outcome.

Adult↗
PubMed1998

Revision arthroplasty of femoral cortex defect using a noncemented stem, Mennen plate, and bone graft.

Twelve patients who underwent total hip replacement complicated by aseptic loosening with severe bone loss were included in this study. Two patients had aseptic loosening of the second revision, six of the third revision, and the remaining four patients of the fourth revision total hip replacement. In all patients, the radiographs revealed an extremely thin cortex around the stem of the prosthesis and almost complete disappearance of one cortex. All patients were treated by revision total hip replacement in conjunction with Mennen plate fixation and allograft bone support. The allograft bone support included three cortical struts and nine massive bone grafts that used cement as a strew. The results were satisfactory in 10 patients in respect to functional activity, pain and radiographic evaluation. In two patients who underwent their fifth revision, the results were unsatisfactory but better than before the operation. Mennen plate fixation provides a sufficient and easy technique for aseptic loosening of total hip replacement with severe bone loss. By preserving the periosteal blood supply, the time required for bone graft incorporation is shortened, resulting in an early final outcome.

Aged↗
PubMed1998

Glenoid fracture: conservative treatment versus surgical treatment.

Glenoid fossa fractures are rare. The indication for conservative or surgical treatment is controversial, especially because of limited reports in the literature. Many authors prefer conservative treatment for most types of glenoid fractures to the alternate surgical treatment, but long-term follow-up is rarely reported. We report on four patients with displaced, intra-articular glenoid fossa, who were treated either surgically or conservatively. After an average 7-year follow-up, clinical and radiographic results were satisfactory in all patients. Based on the literature and our limited experience, we recommend that conservative treatment be considered as a good option for displaced intra-articular glenoid fossa fracture.

Adult↗
PubMed1998

Urografin injection demonstrated soft tissue ganglion communication with an intraosseous ganglion cyst.

Intraosseous ganglion cysts rarely occur in the hand or wrist. We present a case of a soft tissue ganglion cyst that communicated with the intraosseous ganglion of the scaphoid. Typical diagnostic studies include radiography, computed tomography, and magnetic resonance imaging. The diagnosis was made in this case by injection of Urografin into the soft tissue ganglion. The patient underwent excision of both ganglion cysts, resulting in a satisfactory outcome.

Adult↗
PubMed1998

Femoral bone reconstruction in revision total hip replacement.

Twelve patients who had undergone total hip replacement complicated by aseptic loosening with severe bone loss were included in this study. Eight of these patients had aseptic loosening of more than the second revision and the remaining four patients of the fourth revision total hip replacement. In all patients, the radiographs revealed an extremely thin cortex around the stem of the prosthesis and almost disappearance of one cortex. All patients were treated by revision total hip replacement in conjunction with Mennen plate fixation and bone graft support. The results were satisfactory in ten patients in respect to functional activity, pain, and radiographic evaluation. In two patients who underwent their fifth revision, the results were unsatisfactory but better than that before the operation. Our conclusion is that Mennen plate fixation provides a sufficient and easy operative technique for the correction of aseptic loosening of total hip prostheses accompanied by severe bone loss.

Activities of Daily Living↗