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N Haramati

Publications and source records attributed to N Haramati.

33 records · Page 2Linked to original sources
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↗
PubMed1993

The flipped meniscus sign.

Meniscal fragments may be difficult to detect on magnetic resonance (MR) imaging and yet are clinically significant. This paper describes and illustrates the MR appearance of an easily overlooked meniscal fragment. Ten knees, each appearing to show an abnormally large anterior meniscal horn (8 mm or more in height) were prospectively identified on MR images. In each case demonstrable large tears of the ipsilateral posterior horns were present (same meniscus as had large anterior horns). The lateral meniscus was involved in nine cases and the medial in one. Two of the ten patients imaged had surgically proven bucket-handle meniscal tears as well as meniscal fragments overlying the ipsilateral anterior horn. In one case previous MR imaging at our institution had demonstrated the affected anterior horn to be of normal caliber. The striking MR appearance of an abnormally enlarged anterior meniscal horn in association with a tear of the ipsilateral posterior horn suggests the presence of a meniscal fragment or of a posteriorly detached bucket-handle tear of the posterior horn of the meniscus.

Female↗
PubMed1993

MRI of soft tissue abnormalities: a primary cause of sickle cell crisis.

The early manifestations of sickle cell crisis in soft tissues are important to recognize, though rarely manifest on radiographs and difficult to evaluate on computed tomography and bone scans. Documentation is critical, however, if appropriate judgments as to emergency treatment versus conservative measures are to be made. Seventeen adults seen in the emergency room or hospitalized in presumed sickle cells crisis underwent magnetic resonance imaging within 24-72 h of presentation. Results indicate that magnetic resonance imaging is a sensitive modality for documenting early soft tissue pathology which may be the predominant or sole cause of sickle cell crisis.

Adult↗
PubMed1991

Radiocontrast-associated renal dysfunction: incidence and risk factors.

Contrast-induced nephropathy is a potentially serious untoward reaction to radiologic contrast media. The incidence of this nephropathy and the predisposing conditions are not well established, possibly because of methodologic differences between studies. We evaluated the incidence of contrast-induced nephropathy after femoral arteriography in 394 patients by using multiple definitions (different increases in serum creatinine or blood urea nitrogen levels at various times). When an increase in the level of serum creatinine of greater than 0.3 mg/dl and greater than 20% on day 1, 2, or 3 and on day 5, 6, or 7 was used to define the disorder, the incidence in our group of patients was 10% for nonazotemic patients vs 30% for azotemic patients (p less than .001); 2% for nondiabetic, nonazotemic patients vs 16% for diabetic, nonazotemic patients (p = .003); and 38% for patients who were both diabetic and azotemic vs 16% for diabetic, nonazotemic patients (p = .022). Baseline renal insufficiency and diabetes mellitus (especially when insulin dependent) were significant predisposing factors. The effects of dehydration and increased volume of contrast medium on the incidence of contrast-induced nephropathy were not clear; the age and sex of the patient were not important risk factors. The incidence of contrast-induced nephropathy depends on the definition used. Although contrast-induced nephropathy may develop in any patient, diabetes, renal insufficiency, and, possibly, dehydration and dose of contrast medium are risk factors.

Acute Kidney Injury↗
PubMed1991

Radiocontrast-associated renal dysfunction: a comparison of lower-osmolality and conventional high-osmolality contrast media.

Nephropathy is an established untoward event associated with intravascular administration of conventional high-osmolality contrast media (HOM). It has not been shown previously that lower-osmolality contrast media (LOM) are less nephrotoxic in a clinical setting. We evaluate the ability to replace HOM with LOM (in lower-extremity angiography) to reduce the incidence of nephropathy. We use multiple definitions for contrast-induced nephropathy (six different magnitudes of rise of serum levels of creatinine or blood urea nitrogen in various periods). The incidences of nephrotoxic effects with LOM vs HOM in patients with presumed risk factors, including preexisting renal insufficiency and diabetes, are evaluated also. When all patients are considered, the incidence of contrast-induced nephropathy for LOM vs HOM (defined as an increase in serum creatinine level greater than 0.3 mg/dl and greater than 20% on day 1, 2, or 3 and on day 5, 6, or 7, is 7% vs 26% (p = .001). When only patients with preangiography azotemia are considered, the incidence of contrast-induced nephropathy for LOM vs HOM is 10% vs 41% (p = .017); for diabetic patients, regardless of preangiography creatinine level, the incidence is 10% vs 31% (p = .012). Although contrast-induced nephropathy may develop even in a patient with no risk factors who receives LOM, LOM is associated with a decreased incidence of this condition, to various degrees, depending on the presence of risk factors.

Acute Kidney Injury↗
PubMed1991

Magnetic resonance imaging of the foot and ankle.

Beginning with its early success in the hip and knee, magnetic resonance has been universally acknowledged as a major advance in musculoskeletal imaging. Subsequent technical improvements encouraged its rapid adaptation for delineating wrist and shoulder joint pathology. In part because of the small, complex curvilinear structures involved, however, the required technology as well as the potential advantages of magnetic resonance imaging in the ankle and foot were realized only recently. This article illustrates some of the clinical applications of magnetic resonance imaging in foot and ankle pathology.

Ankle↗
PubMed1988

CT diagnosis of circumcaval ureter.

Variability in the normal course of the ureter makes it difficult to differentiate a normal variant from a congenital anomaly or deviation caused by a mass. CT can be useful in making this distinction. We present five cases of circumcaval ureter in which contrast-enhanced CT, by showing the ureter passing posterior and medial to the inferior vena cava (IVC), provided the definitive diagnosis. In addition, we studied the position of the inferior vena cava in the midlumbar region in 100 consecutive contrast-enhanced CT scans and compared the results with the position of the IVC in our five cases of circumcaval ureter plus one case of circumcaval ureter taken from the literature. Whereas only 6% of the normal patients had an IVC lateral to the right pedicle of the third lumbar vertebra, all of the patients with a circumcaval ureter and the one case in the literature had the IVC lateral to the pedicle. Therefore, the finding of a laterally placed IVC on CT is suggestive but not pathognomonic of circumcaval ureter. Contrast-enhanced CT can be used to prove the diagnosis of circumcaval ureter, and lateral placement of the IVC on non-contrast-enhanced CT suggests the diagnosis.

Adult↗
PubMedDate not supplied

Surgical sutures: MR artifacts and sequence dependence.

Artifact reduction is fundamental to the daily clinical application of magnetic resonance (MR) imaging. Imaging of the postoperative patient may be difficult because of surgically introduced materials that result in artifacts. The authors tested some commonly used types of surgical suture for MR susceptibility artifact with various imaging sequences. Ten different suture types were studied. Suture was immersed in vegetable oil in separate plastic test tubes. The sutures were also studied embedded in meat. All samples were studied with T1-weighted and T2-weighted spin-echo, STIR (short-inversion-time inversion-recovery), and two-dimensional and three-dimensional gradient-echo sequences. Silk suture produced the most artifact.

Animals↗
PubMedDate not supplied

CT scans through metal scanning technique versus hardware composition.

OBJECTIVE: Streak artifact on CT scans of metal containing areas has been a long standing problem. Although several artifact reducing methods have been used to improve image quality, most have been limited by requiring specialized equipment or lengthy complex calculations that are not automated. Others have shown that increasing the beam energy results in increased thickness of metal that may be imaged by CT without severe image degradation. We have studied the image quality of bone surrounding metal both with titanium and cobalt-chrome prostheses using various scanning techniques. METHODS: In a double blind fashion, 28 radiology residents and attendings were surveyed as to the best technique for imaging bone detail surrounding metal. A series of images was arranged of an implanted titanium prosthesis, a cobalt-chrome prosthesis and a pelvis repaired with stainless steel pelvic reconstruction plates. Scans were performed using three techniques: 120 kVp, 170 mA, 2 s, 360 degrees rotation, 140 kVp, 140 mA, 3 s, 360 degrees rotation, 140 kVp, 140 mA, 4 s, 420 degrees rotation. RESULTS: Titanium was superior to cobalt-chrome (p < .0001 Wilcoxon Signed Rank Test). No advantage was noted for higher kVp or increased scan arc of 420 degrees compared to the standard 360 degrees. CONCLUSION: Titanium allows improved bone detail surround the metal than CT cobalt-chrome. We have found no advantage to using either high kVp or a 420 degrees scan arc to improve the image quality of bone surrounded by metal.

Acetabulum↗
PubMedDate not supplied

Proximal wrist imaging.

Ligamentous injuries to the triangular fibrocartilage are often difficult to evaluate. The plain film examination along with the physical examination serves as the basis for the initial assessment of most wrist injuries. Ligamentous injuries of the wrist often present at the subacute or chronic state with the physical examination and plain films being insufficient to make a definitive diagnosis in many cases and the plain film radiographic exam being of little additional value. This paper reviews the triangular fibrocartilage complex including the underlying anatomy and biomechanics, along with its radiographic evaluation by modern imaging techniques.

Carpal Bones↗
PubMedDate not supplied

Calcification of the ligamentum arteriosum in adults: CT features.

OBJECTIVE: The present study describes the frequency and pattern of ligamentum arteriosum calcification seen on chest CT in adults. MATERIALS AND METHODS: We retrospectively reviewed 402 sequential unenhanced chest CT studies for ligamentum arteriosum calcification, atherosclerotic cardiac or aortic calcification, and granulomatous calcification. The pattern of calcification was characterized as curvilinear, punctate, or clumped. RESULTS: Mean patient age was 60 (+/- 18, range 18-97) years with 214 women (53%) and 188 men (47%). Of these patients 194 (48%) had calcification in the ligamentum arteriosum including 26 (6%) with calcification in the ligamentum arteriosum alone, 108 (27%) with atherosclerotic calcification, 11 (3%) with granulomatous calcification, and 49 (12%) with both. A total of 100 patients (25%) had no calcifications. In the study population 169 patients (42%) had atherosclerotic calcification, 32 (8%) had granulomatous calcification, and 75 (19%) had both. The patterns of calcification for the 26 patients with calcification of the ligamentum arteriosum alone were curvilinear (7 patients, 27%), punctate (17 patients, 65%), and clumped (2 patients, 8%). The pattern of ligamentum arteriosum calcification for the 108 patients with only atherosclerotic and ligamentum arteriosum calcification was curvilinear (28 patients, 26%), punctate (32 patients, 30%), and clumped (48 patients, 44%). The patients without any calcifications and the patients with ligamentum arteriosum calcification formed one group (based on their similarity in age, mean 47 years) with a prevalence of ligamentum arteriosum calcification of 21%. The patients with atherosclerotic and ligamentum arteriosum calcification formed a second group (mean age 71 years) with a prevalence of ligamentum arteriosum calcification of 65%. CONCLUSION: On unenhanced chest CT calcification of the ligamentum arteriosum is a common finding in adults and increases in prevalence with increasing age and atherosclerosis.

Adolescent↗