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Biomedical subjects

R H Wilkinson

Publications and source records attributed to R H Wilkinson.

At least 37 records · Page 2Linked to original sources
PubMed1988

Osteoporotic sacral fractures: a clinical study.

Traumatic sacral fractures are most often due to motor vehicle or industrial accidents and are commonly associated with pelvic, urogenital, and neurological injuries. In recent years, a more subtle type of sacral fracture, not associated with major trauma, has been described. It is an osteoporotic insufficiency fracture that presents as low back pain in elderly patients, especially postmenopausal Caucasian women. It may escape detection unless radionuclide bone scans, tomograms, or computed tomograms are obtained. The radiographic features have been detailed in various publications, but little has been reported about the clinical features, treatment, or ultimate outcome of patients with osteoporotic sacral fractures. We have reviewed the charts and radiological studies of 13 women and 3 men who sustained this type of fracture between 1983 and 1986. All of these patients were Caucasian. The average age was 71 years. The most common presenting symptom complex was diffuse low back pain accompanied by hip, buttock, or thigh pain. Pertinent physical findings were limited to tenderness on palpation of the sacrum and a decreased range of low back motion. The osteoporotic fractures were seldom noted on plain roentgenograms of the sacrum, but were readily defined by sacral tomography or computed tomography. Radionuclide bone scanning also proved helpful in making the diagnosis by localizing the process. Treatment was medical and consisted of therapies designed to reduce pain and to combat the associated osteopenia. Of our 16 patients, 11 had complete pain relief, 2 had substantial pain relief, 2 noted decreasing pain before they died of other causes, and 1 was followed less than 1 month.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Arthritis in children.

Arthritis in children may be caused by many diseases and disorders. Some processes may be aborted by early diagnosis and treatment. Others may not cause true arthritis until the adult years, with a variable latent period. The spectrum includes congenital malformations, neoplasia (benign and malignant), infection, trauma, hematologic/vascular disorders, and connective tissue diseases. In all instances, early diagnosis is important. The growing skeleton has great potential to remodel if it is given adequate time.

Adolescent↗
PubMed1987

Intraperitoneal chromic phosphate P 32 as salvage therapy for persistent carcinoma of the ovary after surgical restaging.

From 1977 through 1984, 23 patients with persistent epithelial carcinomas of the ovary received intraperitoneal instillation with chromic phosphate P 32 suspension as salvage therapy after second- or third-look laparotomy. Patients received a median 10 cycles of chemotherapy before chromic phosphate P 32. Disease consisted of microscopic residual only in 10 patients (43%), macroscopic residual that was completely resected in eight (35%), and macroscopic residual disease in which the largest diameter was less than 0.5 cm in five patients (22%). Ten patients are free of disease at 13 to 94 months after chromic phosphate P 32 salvage therapy. Life table survival is 75% at 2 years and 57% at 4 years, with a disease-free survival rate of 54% at 2 years and 27% at 4 years. Patients with no gross residual disease had median disease-free survival of 27 months versus 9 months for patients with macroscopic residual disease (p greater than 0.1). Only three patients (13%) developed surgical bowel complications related to chromic phosphate P 32. Compared with previous studies, intraperitoneal chromic phosphate P 32 as salvage therapy for patients with minimal residual ovarian carcinoma defined at secondary surgical evaluation results in comparable survival and fewer complications than does salvage abdominopelvic irradiation and should be considered as an option to further chemotherapy in selected patients.

Actuarial Analysis↗
PubMed1987

Breast cancer. Experiences with conservation therapy.

A series of 1,504 patients with clinically node-negative carcinoma of the breast treated by breast conservation has been followed for 26 years. The majority did not have an axillary dissection. A relative survival of 84% at 5 years and 72% at 10 years compares favorably with reported survival rates for radical surgery. Postoperative irradiation does not influence survival but breast irradiation reduces relapse in the breast. Irradiation of the regional nodes is unnecessary. Lumpectomy alone in clinically node-negative patients produces a survival rate equivalent to more radical treatment. Younger patients had larger tumors, an increased risk of breast relapse, and reduced survival. Local or distant relapse was not a function of estrogen receptor (ER) or progesterone receptor (PR) status.

Adult↗
PubMed1987

Carcinoid liver metastases. Accuracy of radionuclide liver/spleen imaging compared to computed tomography.

Carcinoid liver metastases may be more easily detected by radionuclide liver-spleen studies (RN imaging study) than by computed tomography (CT). While multiple studies have suggested that CT is a more sensitive test than the Tc-99m sulfur colloid study for the detection of most types of liver metastases, carcinoid tumors appear to be an exception. The results of 23 pairs of CT and RN imaging studies that were obtained within one month of each other in patients with proven carcinoid tumors are reported. Comparison of the initial reports of the studies as well as a blinded reinterpretation of the studies suggest that in this group of patients the RN imaging study appeared to be superior to CT in the evaluation of the response to therapy.

Carcinoid Tumor↗
PubMed1987

Weekly high-dose methotrexate and doxorubicin for osteosarcoma: the Dana-Farber Cancer Institute/the Children's Hospital--study III.

Weekly high-dose methotrexate with leucovorin rescue and vincristine (HDMTX) and doxorubicin was administered as adjuvant postoperative therapy to 46 patients with a diagnosis of conventional high-grade nonmetastatic osteosarcoma of an extremity between July 1976 and December 1981. The primary lesions were managed by wide or radical amputation (26 patients) or by limb-sparing resection in 20 selected patients. The margins of the resections were retrospectively classified as marginal in three, wide in 16, and radical in one. The 5-year relapse-free survival (RFS) for all patients is 59% (95% confidence interval [CI], 43%, 74%) and overall survival is 78% (95% CI, 65%, 91%). The RFS for patients initially having a limb resection procedure is 55% (95% CI, 32%, 77%) compared with 62% (95% CI, 43%, 81%) for those initially having amputations (P = .52). Using multivariate analysis, the only significant prognostic variables that predicted RFS of greater than or equal to 3 years, were the presence of moderate to marked lymphocytic infiltration of the primary tumor (P less than .002), primary site outside of the proximal humerus (P less than .005), and the absence of a predominance of osteoblastic pattern in the primary tumor (P less than .03).

Actuarial Analysis↗
PubMed1987

Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation.

Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We reviewed vitamin B12 assays on 1599 consecutive patients and prospectively studied all patients with low serum B12 levels (n = 75) and a random sample of patients with normal levels (n = 68). Of 96 evaluable patients, 7 had clinical deficiency. All 7 deficient patients had urinary methylmalonic acid levels greater than 5 micrograms/mg creatine (sensitivity, 100%; confidence interval, 65% to 100%). Of the 89 patients who were not clinically deficient, 88 had urinary methylmalonic acid levels less than or equal to 5 micrograms/mg creatinine (specificity, 99%). The overall test accuracy in this population was 99%. If the high sensitivity and specificity of the gas chromatography-mass spectrometry assay for urinary methylmalonic acid is supported by other clinical studies, the methylmalonic acid assay may become the reference standard for the diagnosis of vitamin B12 deficiency.

Aged↗
PubMed1987

Femoral anteversion.

Biplane roentgenography, axial roentgenography, and fluoroscopy are the usual roentgenographic methods of measuring femoral anteversion. These methods use a strict geometrical definition of anteversion. The computerized tomography method of measuring anteversion that was developed recently, and is now widely used, does not adhere to the accepted definition of anteversion and has not been tested for accuracy in a large series. In the present study, the widely used computerized-tomography method of measuring anteversion was tested on thirty-two femoral specimens. With that method, anteversion was consistently underestimated by an average of 10 degrees compared with direct measurements and was reproducible only to within +/- 3.6 degrees. Therefore, a new method of measuring anteversion using computerized tomography was developed. It was shown to be accurate to +/- 1 degree, as tested on the same specimens. This study demonstrated geometrically why the currently practiced computerized-tomography method of selecting the points that are used to define the axis of the femoral neck is not consistent with geometrical definitions of anteversion. A more accurate method for both defining the axis of the femoral neck and measuring femoral anteversion is described and recommended for clinical use.

Cadaver↗
PubMed1986

The radiologic "lead band" revisited.

After prolonged heavy metal exposure (e.g., lead) "lead bands" develop at the metaphyseal ends of growing bones. These "lead bands," while a constant finding, are used as additional laboratory evidence to diagnose plumbism. In this study, the role of the proximal fibula in distinguishing physiologic sclerosis from pathologic thickening of the zone of provisional calcification is assessed. In addition, laboratory values are compared to radiographic findings in a controlled fashion to establish levels at which "lead bands" appear. The former is a useful adjunct in the radiographic diagnosis of plumbism, while the minimum blood levels at which "lead bands" are seen is much lower than previously described.

Bone and Bones↗
PubMed1986

Bilateral urinothorax identified by technetium-99m DPTA renal imaging.

A case of unilateral urinary tract obstruction with extravasation resulting in bilateral pleural effusions is presented. The fluid within the pleural cavities was established to originate from the kidney using [99mTc]diethylenetriaminepentaacetic acid and scintillation camera imaging.

Female↗
PubMed1986

The association of femoral retroversion with slipped capital femoral epiphysis.

We examined twenty-five patients who had a unilateral or bilateral slip of the capital femoral epiphysis and determined the degree of anteversion of the thirty-nine involved hips with computerized axial tomography. Thirteen patients (eighteen hips) were seen at the time of the original diagnosis (Group I), and twelve patients (twenty-one hips) were seen one to seven years after operative treatment (Group II). The mean amount of anteversion for all of the involved hips was +1.0 +/- 8.2 degrees. The mean amount of anteversion for the Group-I hips was -0.7 +/- 7.4 degrees and the mean amount for the Group-II hips was 2.5 +/- 8.7 degrees. The mean amount of anteversion for the hips in both Groups I and II was less than the predicted mean amount for individuals of the same age. The mean amount of anteversion of the unaffected hips of our patients who had a unilateral slip was +6.3 +/- 8.2 degrees. The amount of internal rotation of the hip in extension exceeded the amount when it was in flexion in all of the patients. A decreased angle of femoral anteversion appears to be specifically associated with the development of slipped capital femoral epiphysis. The mechanical forces that act across the proximal femoral physis may be altered by this rotational abnormality, and this may lead to an increased shear stress that ultimately causes failure of the growth plate.

Adolescent↗
PubMed1986

Nonexpression of cartilage type II collagen in a case of Langer-Saldino achondrogenesis.

A lethal short-limbed dwarfism was diagnosed at autopsy as the Langer-Saldino variant of achondrogenesis by radiological, histological, and gross pathological criteria. Cartilage was obtained for biochemical and ultrastructural analyses from the ends of long bones, from ribs and from a scapula of the newborn infant. At all sites, it had an abnormal gelatinous texture and translucent appearance. Biochemical analyses of the cartilages to identify pepsin-solubilized collagen alpha-chains and collagen-specific CNBr-peptides failed to detect type II collagen at any site where it would normally be the main constituent. Instead, type I was the predominant collagen present. However, three cartilage-specific minor collagen chains identified as 1 alpha, 2 alpha, and 3 alpha chains by their electrophoretic mobility were present at about 10% of the total collagen. Cartilage-specific proteoglycans also appeared to be abundant in the tissue judging by its high hexosamine content and high ratio of galactosamine to glucosamine. The findings indicate that a chondrocyte phenotype had differentiated but without the expression of type II collagen. In addition to the skeletal abnormalities, the severe pulmonary hypoplasia was also felt to be directly related to the underlying pathology in collagen expression. The term chondrogenesis imperfecta rather than achondrogenesis should be considered a more accurate description of this and related conditions.

Bone and Bones↗
PubMed1985

Bone scintigraphy and radiography in young athletes with low back pain.

Radiographs and bone scans of 40 young athletes with low back pain were reviewed retrospectively to correlate the imaging findings and assess the value of scintigraphy in the diagnosis of these patients. The radiographs were positive for spondylolysis with or without spondylolisthesis in 15 (38%), and scintigraphy showed focal disease in the posterior vertebral elements in 14 (35%). Five patients had positive radiographic studies but normal scans, indicating old injuries; four patients had positive scintigrams but normal radiographs, suggesting early or active injuries. The authors use radiography as the initial examination in the evaluation of patients with low back pain. Scintigraphy is most useful in early stages, when radiographs may be normal; and in cases in which the age and activity of a radiologic abnormality cannot otherwise be accurately determined before therapy.

Adolescent↗
PubMed1983

Dynamic radionuclide imaging as a means of evaluating vascular perfusion of the upper extremity: a preliminary report.

Vascular competence in the upper extremities of 44 patients was evaluated by three-phase bone scans consisting of rapid sequence dynamic radionuclide imaging (DRI), an immediate postinjection "blood pool" image, and a 3- to 4-hour delayed image. Findings were correlated with definitive anatomy determined by arteriography, operative findings, or both, in 50 extremities. DRI provided the correct diagnosis in all but four extremities (92%). Limited resolution precluded precise anatomic definition of aneurysms in three limbs and of digital artery occlusion, with adequate collateral circulation in the fourth limb. The greatest value of DRI was its provision of quantitative information about relative blood flow and preferential perfusion in every instance. We believe DRI to be a useful adjunct to preoperative and postoperative assessment of arterial perfusion.

Adult↗
PubMed1983

Assessment of fat malabsorption.

For the assessment of fat malabsorption, the standard method of measuring faecal fat excretion using a 5 day stool collection has been compared with the alternative methods: stool microscopy, a lipid tolerance test and a continuous marker technique for the estimation of fat content on a single stool sample. The lipid test, using an emulsion of arachis oil (Prosparol), was less reliable than had been expected with a sensitivity of 33% and a specificity of 45.4%. Stool microscopy using Oil Red O to stain fat globules had a sensitivity of 72.2% and a specificity of 95.4%. Fat estimation of a single stool sample using copper (1) thiocyanate showed a high correlation with that determined on a 5 day stool collection (p less than 0.001). It is concluded that lipid tolerance tests have little place in the estimation of fat absorption. In laboratories where faecal fats are not measured, microscopic examination of stool for fat globules provides a specific and relatively sensitive method for detecting steatorrhoea. The use of a continuous marker provides a method for assessing the degree of steatorrhoea on a single stool sample without the disadvantages of the conventional method of faecal fat analysis.

Celiac Disease↗
PubMed1983

Artifacts in iodine-131 renal images due to coincidence summing of technetium-99m photons.

Technetium-99m gamma camera images of kidneys produced with an iodine-131 energy window showed "ghosts" over and between the kidneys and between the kidneys and the bladder. The cause was coincidence summing at 281 keV due to a high 99mTc counting rate. In older model cameras careful peaking with a proper energy window reduces this effect; more recently developed cameras with pileup rejection circuits do not have this problem.

Humans↗
PubMed1983

Observations on the intraperitoneal distribution of chromic phosphate (32P) suspension for intraperitoneal therapy.

Seven patients received intraperitoneal chromic phosphate (32P) suspension in a 3-ml bolus with a saline flush, and another ten patients were given the suspension in a 500-ml infusion of normal saline. During the first six hours after administration, most 32P activity redistributed to the gravity-dependent portion of the peritoneal cavity. From 24 hours up to seven weeks after administration, activity distributions were fixed. Dispersions were heterogeneous in every patient, but the most marked examples of localized activity occurred in patients who had received bolus injections. We concluded that large-volume infusions and frequent changes in patient position for several hours following the infusion, contribute to improved dispersion of 32P suspension.

Chromium↗