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Biomedical subjects

N Haramati

Publications and source records attributed to N Haramati.

At least 19 recordsLinked to original sources
PubMed2000

The diagnostic role of gadolinium enhanced MRI in distinguishing between acute medullary bone infarct and osteomyelitis.

The objective of the study was to evaluate the diagnostic utility of contrast enhanced magnetic resonance imaging (MRI) for distinguishing between acute medullary bone infarct and osteomyelitis. There were 11 patients (age 6-34 years) presented to our institution between December 1994 and February 1998 with a clinical differential diagnosis of acute bone infarct versus osteomyelitis and inconclusive radiographs were imaged using MRI. All but one received i.v. gadolinium. Nine of the patients had homozygous Sickle Cell disease (SCD) and two had Systemic Lupus Erythematosus (SLE), the latter requiring chronic methylprednisolone. Osteomyelitis was confirmed either by biopsy alone or by the combination of Gallium(67) scan in conjunction with positive blood cultures and clinical resolution following antibiotics. Infarcts without osteomyelitis were confirmed either by biopsy or resolution of symptoms without antibiotic therapy. All patients had at least six months clinical follow-up. The results found that seven of nine patients with SCD had acute infarct only. One patient with SCD had osteomyelitis only. Three patients (two SLE and one SCD) had both acute-on-chronic infarcts and superimposed osteomyelitis, one with an adjacent soft tissue abscess. Accurate distinction between infarct and osteomyelitis was impossible for one patient with SLE who did not receive contrast. All other cases were correctly diagnosed prospectively based on distinct patterns of MRI contrast enhancement. In all adult patients, acute infarcts demonstrated thin, linear rim enhancement on MRI while osteomyelitis revealed more geographic and irregular marrow enhancement. Two of four cases of osteomyelitis also demonstrated subtle cortical defects with abnormal signal traversing marrow and soft tissue. The single pediatric patient demonstrated elongated, serpiginous central medullary enhancement with periostitis. We concluded that the pattern of MR contrast enhancement may allow accurate distinction between acute infarct and osteomyelitis, or recognition of osteomyelitis superimposed on bone infarction.

Adolescent↗
PubMed1999

Computerized bone densitometric analysis: operator-dependent errors.

PURPOSE: To determine the nature and relative frequency of operator-dependent data analysis errors in dual x-ray absorptiometry. MATERIALS AND METHODS: Over 40 months, 2,528 dual x-ray absorptiometric examinations of the forearm, femoral neck, and lumbar spine were performed by 11 technologists by using standard techniques and software. Each analysis was reviewed by a radiologist; errors were recorded and corrected. RESULTS: There were no forearm analysis errors. There were 24 (0.9%) femoral neck analysis errors, of which 23 resulted from misplacement of the analysis region. There were 33 (1.3%) spinal analysis errors, of which 24 resulted from misplacement of intervertebral disk space markers. Analysis errors of the femur and spine resulted in six misdiagnoses (0.2%). CONCLUSION: Misdiagnosis due to analysis errors is rare. Femoral neck analysis errors were easily detectable, but accurate spinal analyses depended on accurate identification of vertebral end plates and posterior elements. Nonetheless, these potentially serious errors can be detected and corrected if the analyses are reviewed and interpreted by a supervising physician who is familiar with the relevant anatomy, proper analysis techniques, and factors--such as artifacts--that adversely affect the accuracy of the analysis.

Absorptiometry, Photon↗
PubMed1998

Slipped capital femoral epiphysis: a physeal lesion diagnosed by MRI, with radiographic and CT correlation.

OBJECTIVE: To define and compare early lesions associated with slipped capital femoral epiphysis (SCFE) on magnetic resonance imaging (MRI), computed tomography (CT) and radiography. DESIGN AND PATIENTS: Thirteen patients with 15 symptomatic hips due to SCFE underwent radiography and MRI; CT was performed in 12 patients. SCFE was graded on radiographs, head/neck angles and qualitative changes were evaluated on CT, and morphologic/signal abnormalities were determined on MRI. RESULTS: Physeal widening, apparent on T1-weighted MRI, was evident in every case of SCFE, including one presumed "pre-slip." T2-weighted images demonstrated synovitis and marrow edema but obscured physeal abnormalities. CT head/neck angles ranged from 4-57 degrees for symptomatic to 0-14 degrees for asymptomatic hips. Physeal and metaphyseal changes were variably identified on both radiographs and CT in all cases of SCFE, but not in the pre-slip. CONCLUSION: MRI clearly delineates physeal changes of both pre-slip and SCFE, and demonstrates very early changes at a time when radiographs and CT may appear normal.

Adolescent↗
PubMed1998

Complications related to osteopenia in the thoracic spine on admission chest radiographs of substance abuse detoxification patients.

OBJECTIVE: To assess the prevalence of complications related to osteopenia in the thoracic spine (anterior wedging and fish vertebrae) of patients admitted for substance abuse detoxification. DESIGN AND PATIENTS: We retrospectively identified 150 sequential patients admitted to our drug and alcohol detoxification ward in whom posteroanterior and lateral admission chest radiographs and clinical charts were available for review. There were 116 men and 34 women with a mean age of 37 years (range 19-67 years). Thirty-eight patients were admitted for drug detoxification, 37 for alcohol detoxification, and 75 for drug and alcohol detoxification. These patients were compared with 66 age- and sex-matched controls from our hospital's employee health service. Two radiologists reviewed all chest radiographs for the presence of anterior wedging and fish vertebrae in the thoracic spine and other nonspinal fractures. Serum calcium and inorganic phosphorus levels were recorded for the substance abuse detoxification patients. RESULTS: Forty-nine percent (n=73) of detoxification patients had complications of osteopenia in the thoracic spine including: anterior wedging (n=47), fish vertebrae (n=21), or both (n=5). Twenty-four percent (n=36) of patients had an elevated serum inorganic phosphorus level and one patient had an elevated serum calcium level. Patients with anterior wedging or fish vertebrae included: 45% (n=45) of patients below age 40 years, 35% (n=12) of women, 41% (n= 15) of drug detoxification patients, 58% (n=22) of alcohol detoxification patients, 48% (n=36) of drug and alcohol detoxification patients, and 47% (n=17) of patients with elevated serum inorganic phosphorus (P=NS). Six percent (n=9) of our study population had nonspinal fractures on their chest radiographs. Twenty-one percent (n=14) of controls had complications of osteopenia in the thoracic spine (all anterior wedging). This prevalence differed significantly (P<0.05, chi-squared) from the study population. CONCLUSION: Osteopenia-related anterior wedging and fish vertebrae in the thoracic spine are common findings on chest radiographs of patients hospitalized for substance abuse detoxification. Serum inorganic phosphorus and calcium levels did not correlate with the presence of anterior wedging or fish vertebrae.

Adult↗
PubMed1997

Magnetic resonance imaging and computerized tomography of a gravid leopard tortoise (Geochelone pardalis pardalis) with metabolic bone disease.

Secondary nutritional metabolic bone disease was diagnosed in a gravid leopard tortoise (Geochelone pardalis pardalis). Diagnosis was based upon history, physical examination, hematology, plasma biochemistry, and radiography. Despite induced oviposition and treatment of metabolic bone disease for 8 wk, the tortoise's condition deteriorated. Repeat radiographs demonstrated gaseous intestinal distention. Oral administration of metoclopramide and mineral oil failed to stimulate defecation. Persistence of the ileus pattern prompted utilization of magnetic resonance imaging (MRI) and computerized tomography (CT). MRI demonstrated brightly enhanced loops of mineral oil-filled small bowel and preovulatory follicles. CT demonstrated dystrophic calcification of the left hepatic lobe and preovulatory follicles and the typical reticular pattern of chelonian lung. The interstitial septa were caused by pulmonary vasculature or bands of smooth muscle.

Animals↗
PubMed1996

Pulmonary pseudonodules on computed tomography: a common pitfall caused by degenerative arthritis.

This study assessed the prevalence of pseudonodules of the lung on computed tomography (CT) related to degenerative arthritis at the distal first rib and sternum. A total of 250 serial chest CT scans were retrospectively reviewed by a chest and a musculoskeletal radiologist. A pseudonodule was defined as a round or oval opacity identified on lung window surrounded by aerated lung and superimposable on an osseous structure on the immediate cephalad slice. The pseudonodules were classified as originating from one of the following three locations: first costochondral junction, first costosternal junction, or sternoclavicular junction. CT slice thickness was 8 mm or 10 mm. For each side, the presence of a pseudonodule and its classification was noted. The presence or absence of degenerative arthritis was also noted for each side. The median patient age of the 111 men and 139 women was 62 years (range, 2-97). Degenerative arthritis was noted bilaterally in 94 (38%) and unilaterally in two. Pseudonodules were present in 29 patients (12%). Eighteen (62%) were men with a median age of 73 years (range, 50-84), and 11 (38%) were women with a median age of 67 years (range, 52-85). All of the patients with pseudonodules had bilateral degenerative arthritis. Twenty-seven pseudonodules were caused by degenerative arthritis at the first costochondral junction, four at the first costosternal junction, and one at the sternoclavicular junction. Fifteen pseudonodules were right sided and 17 were left sided. Three patients had bilateral pseudonodules. Pulmonary pseudonodules caused by degenerative arthritis, most commonly at the first costochondral junction, were present in 12% of our series. This common finding occasionally may be misinterpreted as a true pulmonary nodule.

Adolescent↗
PubMed1996

HLA-DRB1 and DQB typing of Hispanic American patients with rheumatoid arthritis: the "shared epitope" hypothesis may not apply.

OBJECTIVE: To determine whether the association of particular MHC class II alleles and the DRB1 "shared epitope" with disease susceptibility and severity in rheumatoid arthritis (RA) applies to ethnic groups other than Caucasian Americans. METHODS: 67 Hispanic American patients with RA and a similar number of ethnically matched controls were typed for DRB1 using polymerase chain reaction methods. DR4 subtype and DQB1 type were determined for the subjects positive for DR4. Disease severity in the patients with RA was assessed by clinical, radiographic and laboratory variables. RESULTS: The frequency of DR4 was significantly increased in the subjects with RA compared to the control group. However, the "shared" DRB1 amino acid sequence was relatively infrequent in the Hispanic American patients with RA, and there was no association of specific DR4 or DQ alleles with more severe disease or extraarticular manifestations. CONCLUSION: The HLA markers that predict poor prognosis and suggest that more aggressive clinical management may be appropriate in Caucasian American patients with RA may not be useful in other ethnic groups.

Arthritis, Rheumatoid↗
PubMed1995

MRI of the Stener lesion.

OBJECTIVE: To assess the utility of MR in detecting surgically induced Stener lesions (displaced thumb ulnar collateral ligaments) in cadaveric models. DESIGN: Six cadaver thumbs had ulnar collateral ligament (UCL) tears created surgically. MR examinations (2D STIR and 3D GRASS) were performed identically on all specimens both before displacement (non-Stener) and after displacement (Stener lesion) of the UCL. The MR images were then randomly numbered. Each image was evaluated separately in blinded fashion by four musculoskeletal radiologists for the presence or absence of a Stener lesion. Each radiologist reinterpreted the images after an interval of several days. The interpretation was based on previously published criteria for Stener lesion diagnosis by MR. RESULTS: The sensitivity of GRASS ranged from 0.17 to 0.67 with the most experienced reader scoring the lowest. The specificity of GRASS ranged from 0.33 to 1.0 (most experienced reader 0.67, 0.83). STIR had a sensitivity of 0.00-0.17 and a specificity of 0.53-0.83. The kappa values for inter- and intraobserver agreement were measured. The intraobserver kappa for GRASS was 0.27-0.75 (most experienced reader 0.75). CONCLUSIONS: 2D imaging is probably inadequate for the evaluation of Stener lesions. The most likely reason is that the STIR slice thickness of 3 mm limits resolution of small UCLs. The poor sensitivity and specificity of GRASS as well as poor interobserver agreement suggest that MR may not be sufficiently accurate for Stener lesion evaluation.

Humans↗
PubMed1995

Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging.

OBJECTIVE: The purpose of our study was to assess the ability of MR imaging to detect partial tears of the anterior cruciate ligament (ACL) as these injuries, if extensive enough, may result in ligamentous insufficiency or predispose to subsequent acquired knee instability. MATERIALS AND METHODS: A review of all arthroscopic reports from two institutions during the periods 1990-1992 and 1992-1993, respectively, revealed 13 patients with partial tears of the ACL. Thirteen cases each of intact and completely ruptured anterior cruciate ligaments on arthroscopy were randomly selected as controls from the same report review. Preoperative MR images for all cases selected were obtained. Criteria for diagnosis included the absence of findings of complete ACL tear in conjunction with abnormal intrasubstance signal, bowing of the ACL, or nonvisualization of the ACL on one MR imaging sequence with visualization of intact fibers on other sequences. Inter- and intraobserver agreement was assessed using the kappa statistic. RESULTS: The sensitivity of MR imaging for detecting partial ACL tears ranged from 0.40 to 0.75, and the specificity ranged from 0.62 to 0.89. Variability of both inter- and intraobserver interpretations was greater than 0.7 kappa in all but one combination, comparing the diagnostic consistency of each of three readers both with himself, using two readings on separate days, and with each separate interpretation by the other two radiologists. CONCLUSION: Our results show that MR evaluation of partial ACL tears is not sufficiently sensitive to establish the diagnosis without arthroscopy. This study was limited, however, by its small size and by the heterogeneity of the MR imaging technique.

Adolescent↗
PubMed1994

Injection granulomas. Intramuscle or intrafat?

OBJECTIVES: Intramuscular injection is a commonly used route of parenteral drug administration. We studied the fat vs muscle location, the depth of calcified buttock granulomas, and the thickness of subcutaneous fat. Data were assessed with respect to the length of a needle commonly used in intramuscular buttock injections. DESIGN: Three hundred thirty-eight sequential pelvic computed tomographic scans were studied. Subcutaneous fat thickness was measured for each patient at the upper outer quadrant of the buttock. The location and depth of each calcified granuloma were also recorded. SETTING: Tertiary care academic teaching hospital. RESULTS: One hundred sixty-four calcified granulomas were found in 67 patients. One hundred fifty-two of these granulomas were in fat and 12 were in muscle; this was statistically significant using a single-sample binomial distribution (P < .001;95% confidence interval, 0.04 to 0.13). The mean (+/- SD) subcutaneous fat thickness at the upper outer quadrant of the buttock was 5.0 +/- 1.9 cm, with female patients having a mean subcutaneous fat thickness of 5.7 +/- 1.8 cm vs 4.4 +/- 1.7 cm for male patients. CONCLUSIONS: The finding that buttock subcutaneous fat thickness exceeds the length of the most commonly used needle for intramuscular buttock injection (3.8 cm), together with the preponderance of calcified granulomas found in the fat of female patients, suggests that the currently used injection technique may not be therapeutically optimal. We suggest that longer needles be used for intramuscular buttock injections in adults.

Adipose Tissue↗
PubMed1994

Value of the coronal plane in MRI of internal derangement of the knee.

Sagittal images usually receive the most scrutiny in the magnetic resonance evaluation of meniscal and anterior cruciate ligament tears. We assessed the relative contribution of the coronal view. All knee magnetic resonance examinations performed over a 2-year period that had surgical confirmation were reviewed with respect to the presence of meniscal and anterior cruciate ligament tears. The appearance of an attenuated but uninterrupted anterior cruciate ligament was also evaluated. The coronal and sagittal plane images were evaluated separately. The study included 68 medial menisci, 67 lateral menisci, and 71 anterior cruciate ligaments. The coronal view is especially useful in the evaluation of the lateral meniscus. An anterior cruciate ligament that appears attennated but uninterrupted should be considered intact. The anterior cruciate ligament may be evaluated on the coronal view. The coronal view should be regarded as similar to the lateral chest radiograph, which supplements, but does not replace, the frontal chest radiograph.

Anterior Cruciate Ligament↗
PubMed1994

Magnetic resonance imaging of occult fractures of the proximal femur.

The evaluation of the painful hip in the elderly osteoporotic patient with normal plain radiographs can be difficult. We studied 15 osteopenic patients with normal plain radiographs and suspected hip fractures with magnetic resonance (MR) imaging and found MR to be an excellent aid in detecting occult fractures. A clear fracture was seen in 10 of the 15 patients, who then underwent surgical repair based on the MR study. The remaining patients had no MR-demonstrable fracture and were successfully treated nonoperatively. Some believe that a negative bone scan in this population of patients should be repeated within 3 days prior to a definitive "no fracture" decision being made. Unfortunately, bone scanning lacks spatial resolution, and increased osteoblastic activity may be caused by other pathologic processes besides fracture. Two of the 15 patients had MR-demonstrated bone infarcts near the fracture. One patient also had femoral head osteonecrosis on the side of the fracture. One patient with metastatic prostatic carcinoma had a hip fracture and one patient with metastatic breast carcinoma had no fracture. No only is MR imaging an excellent technique for delineating occult fractures, but due to its spatial resolution, associated bone disorders adjacent to fractures can be detected in most instances. From a cost perspective, rapid diagnosis and early treatment of an occult femoral fracture is advisable. A reduced hospital stay pending diagnosis and the early institution of definitive therapy also decrease the chance that a simple non-displaced fracture will displace and require more complex management with resultant increased morbidity and cost.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

MR imaging: its role in detecting occult fractures.

Magnetic resonance (MR) studies were performed on 30 consecutive patients who continued to be symptomatic despite negative or inconclusive findings on radiographs and other imaging studies including radionuclide bone scans, computed tomography, and/or polytomography. There were 9 men and 21 women, 20-92 years old (mean age 63 years) whose MR studies were done 3-72 h after frank trauma in 22 cases and in another 8 after 1-4 weeks of increasing pain subsequently attributed to trauma or unaccustomed effort. MR studies were performed using 0.5-T (Phillips) or 1.5-T (Phillips, GE) superconductive magnets. Results indicated that: (1) MR images allowed identification of acute fractures in an emergency room setting, as well as subtle subacute or chronic fractures in the context of strong clinical suspicions despite negative or inconclusive radiographs and other subsequently indecisive imaging studies. (2) MR imaging is the most sensitive way of documenting the earliest changes in traumatized osseous and soft tissue structures simultaneously.

Adult↗
PubMed1994

Coraco-clavicular joint: normal variant in humans. A radiographic demonstration in the human and non-human primate.

The coraco-clavicular joint is a true synovial joint that may become painful in some patients after trauma. Among the descriptions of this entity is the assertion that the coraco-clavicular joint is routinely seen in gorillas and gibbons. We undertook to assess the incidence of this variant among gorillas, gibbons, and other non-human primates. All available radiographs of large primates performed at the International Wildlife Conservation Park/Bronx Zoo (IWCP) over the past 10 years were reviewed by a musculoskeletal radiologist (human radiology). All radiographs were taken during the normal clinical care of the non-human primate population of the IWCP and are a part of each animal's clinical record. Eighty-one non-human primate radiographs were suitable for study as they contained the region of interest. The 81 radiographic examinations included 14 different species of non-human primates. The coraco-clavicular joint was seen in 4 out of 9 silver-leaf langur, 2 out of 8 lowland gorilla, and in 1 out of 6 white-handed gibbon. In all non-human primate cases where the coraco-clavicular joint occurred, it was bilateral. In 1 out of 8 mandrill, there were very wide distal clavicular ends that articulated both with the coracoid and with the acromion. The coraco-clavicular joint differs from an ossified coraco-clavicular ligament. The radiographic appearance is characteristic and is found in both humans and some non-human primate species. It may rarely become painful following trauma. When symptomatic in humans, resection of this anomalous articulation is curative.

Acromioclavicular Joint↗
PubMed1994

Non-union of pediatric fibula fractures: easy to overlook, painful to ignore.

Fracture non-union in the pediatric population may span the age range from childhood to adolescence. Fracture non-union in children and adolescents is often due to an underlying cause such as affliction with neurofibromatosis or osteogenesis imperfecta. Although less commonly seen, non-union may occur in the otherwise healthy pediatric population. We report three cases of fracture non-union of the distal end of the fibula in the pediatric age group. All three were characterized by persistent local pain and tenderness following injury with radiographic evidence of fracture non-union. All three had undergone conservative treatment with extended periods of immobilization. Following surgery, all three had marked improvement of their local symptomatology. One patient's course was complicated by reflex sympathetic dystrophy syndrome. In two patients, resection of the un-united fragment at the distal fibula resulted in marked relief from pain without any increase in ankle instability. We postulate that the fracture non-union resulted in a fibrotic reaction that was so extensive that ankle stability was maintained even after removal of the fracture fragment.

Adolescent↗
PubMed1994

Abnormal geometry of the distal radioulnar joint: MR findings.

Previously developed criteria of normal distal radioulnar joint (DRUJ) axial geometry were applied to routine magnetic resonance (MR) images of 50 wrists. All wrists lacked clinically evident DRUJ instability. An attempt to apply the three geometric criteria to seven of the cases was not possible, since the prescribed landmarks were not visible. The remaining 43 cases were retrospectively divided into a symptomatic group (25 wrists), with clinical abnormalities referable to the ulnar side of the wrist, and an asymptomatic group (18 wrists), with no such abnormalities. Abnormal DRUJ geometry was found in 12 symptomatic and 2 asymptomatic wrists. This difference between the groups is significant (p = 0.02), suggesting that many symptomatic wrists exhibit different DRUJ geometry than is found in most asymptomatic wrists.

Adolescent↗
PubMed1994

O'Donoghue's triad: magnetic resonance imaging evidence.

OBJECTIVE: The objective was to search for magnetic resonance imaging evidence of medial collateral ligament (MCL) injury in knees with proven tears of the anterior cruciate ligament (ACL) and medial meniscus; the three abnormalities that make up O'Donoghue's triad. Although the MCL injury can be unapparent clinically, knee joint stability may be compromised. DESIGN: The superficial portion of the MCL was evaluated on 19 MR studies of 16 knees with arthroscopically proven ACL and medial meniscal tears. MCL thicknesses were compared to those on MR images of 19 normal knees. PATIENTS: The injured knees were of 13 men and 3 women, ranging in age from 19 to 56 years; the normal knees were of 10 men and 9 women, ranging in age from 19 to 55 years. RESULTS AND CONCLUSIONS: The medial collateral ligaments of all injured knees were abnormal, and, as a group, they had greater thicknesses and more intraligamentous thickness variability than normal knees. The MR appearance of both ACL and medial meniscal tears served as indirect evidence of MCL injury, with irregular MCL thickening indicative of prior injury.

Adult↗