Biomedical subjects
Publications and source records attributed to S Anda.
Intrasacral meningeal cysts are relatively uncommon. They are usually asymptomatic, but because of their expansive character, radicular symptoms or functional disturbances in the urinary bladder or rectum can occur. It is of importance to recognize these cysts in order to give the patient the correct treatment and to avoid unnecessary examinations and operations. The diagnosis can be made by myelography, computer tomography or magnetic resonance imaging.
Anterior sacral meningocele is an uncommon and often occult disorder of clinical importance. The pelvic mass induces symptoms mainly because of its pressure on surrounding organs. Obstipation and urinary symptoms are common. In females, complications due to prolonged or obstructed labour and infections are serious and can be fatal. The radiological manifestation is quite typical. It is important to be aware of anterior sacral meningocele in order to reach the right diagnosis, and to suspect it when typical symptoms are present.
Several extraarticular surgical procedures have been proposed to eliminate the anterolateral rotatory instability of an anterior cruciate-deficient knee. We examined the outcome in 52 patients with an extraarticular transposition of the lateral third of the patellar tendon to the lateral femoral condyle. The mean follow-up time was 9 years. The evaluation was based on the patients' subjective assessment, the Tegner activity level score, range of motion, Lysholm functional score, assessment of knee instability using manual testing as well as arthrometer measurements, and weight-bearing radiographs. At follow-up, 37 patients stated that they had good-to-excellent knee function. The mean Tegner score dropped from a preinjury level of 7 to 5.43 patients had a good-to-excellent Lysholm score. 20 patients had a positive Lachman sign of grade 2 or 3, and 23 patients had a side-to-side difference of more than 3 mm as measured by an arthrometer. 17 had a positive pivot shift sign. 12 patients had meniscal resections performed after the primary operation, and 27 had radiographic evidence of arthrosis. Although the outcome of this technique is equivalent to or better than results reported for other extraarticular procedures, the recurrence rate of symptomatic instability and the deterioration of subjective knee function are too high.
Atlantoaxial rotatory fixation is a disorder which must be considered in persistent torticollis. The disorder occurs mainly in children and young adults. The usual etiological factors are traumas or infections of the upper respiratory tract, but the onset may also be spontaneous. The pathogenesis of the fixation is poorly understood. We describe three patients with atlantoaxial rotatory fixation and demonstrate the usefulness of computerized tomography in the diagnosis of this condition. We recommend a posterior atlantoaxial fusion if conservative treatment fails to reduce the rotatory fixation.
A study has been performed to evaluate whether one or several levels are needed with computed tomography (CT) study to provide sufficient information regarding anteversion and acetabular support to the femoral head. A total of 23 hips in 14 adults with uni- or bilateral congenital hip dysplasia (center-edge angle less than 20 degrees) were assessed by obtaining 5-mm contiguous CT slices and performing acetabular measurements at four levels. Both anterior and posterior acetabular supports as quantified by the anterior and posterior acetabular sector angles were significantly lower than normal at all levels. The sector angles increased in the proximal cuts, whereas the acetabular anteversion increased caudally. Because no important additional information was gained by measuring at different levels, we conclude that CT study at one level is sufficient for acetabular measurements and suggest that the slice through the center of the femoral head is the most appropriate one.
Four patients were successfully treated for vascular complications associated with lumbar disc surgery, one as an emergency case and three from 1 to 3 months postoperatively. Acute complications are often identified by severe bleeding. Knowledge of the anatomy is essential for appropriate surgical repair, which may consist of patch-graft angioplasty or graft interposition. Treatment of late complications (usually arteriovenous fistula or false aneurysm) is often impeded by adhesions. Fistula repair is performed from inside the artery. Precautions against vascular complications during lumbar disc surgery are discussed.
Four cases of vascular complications to anterior perforations during discectomy prompted a CT study to measure lumbar disc diameters and to evaluate the prevertebral anatomy. Fifty young adults who had been referred for low-back pain and/or sciatica but had not undergone operation were included. In five additional patients, prone versus supine CT examinations were compared. Six typical configurations of the vascular anatomy could be classified to explain the type of vascular complications occurring at the L3-4 and L4-L5 disc levels. The sagittal diameter of the three lowest lumbar discs varied from 33 to 56 mm, indicating the importance of this parameter as an intraoperative guideline for the spine surgeon. Air-filled intestines were observed anterior to the L5-S1 disc predominantly in the prone position. The possible relationship between this finding and postoperative discitis is discussed.
During the last few years it has been generally accepted that angiography can be performed on an outpatient basis. In 1988 and 1989, 130 angiographies were done in this manner at the Regional Hospital in Trondheim. All the examinations were carried out by conventional transfemoral technique. After the procedure the patients were observed for six hours in the surgical ward of the hospital before going home. 25 patients had to be hospitalized after examination. Only in two cases this was due to minor complications of the angiography. None of the patients experienced complications after discharge from hospital. The conclusion is that outpatient angiography must be considered a safe and cost-effective procedure.
The CT-examinations of 15 patients with blow-out fractures of the orbital floor were reviewed. All patients were examined with coronal/semicoronal CT-imaging, and 7 patients also were evaluated with semisagittal projections. Only in one case the semisagittal images gave more information than coronal sections when using the classification of Gilbard et al. (1985) of the inferior rectus muscle/fracture relationship. The anterior and posterior fracture margins were better delineated with semisagittal imaging. Two patients exhibiting positive traction tests with hooked, and not entrapped muscles on CT still had diplopia 5 1/2 and 12 weeks after the trauma.
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Fifty-two children with increased femoral anteversion had bilateral derotational subtrochanteric osteotomies at a mean age of 7 years. They were followed prospectively until at least 15 years of age; the mean observation time was 9 years. They were a subset of 95 children whose 2-year results were reported in 1989. The mean increase of femoral anteversion after the osteotomy was 6 degrees (0.7 degrees per year) and of the neck-shaft angle 5 degrees. The CE angle did not increase. Although we at present practice a more restrictive attitude towards operation of increased femoral anteversion, our study showed that a derotational osteotomy is effective in eliminating the intoeing gait and associated complaints, and the hip angles change only moderately during the remaining period of growth.
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Femoral anteversion (AV) was determined by ultrasound in 40 adolescent and adult patients with rotational disorders of the femur, and the results were compared with AV measurements by biplanar roentgenography. With the patients supine, their knees flexed 90 degrees, and their lower legs strapped in the vertical position, one scan only of the proximal femur was needed to measure the anteversion by ultrasound. The transducer was tilted until the desired measuring line appeared horizontal on the monitor screen. The angle of tilt of the transducer, which represented the AV angle, was measured with an attached clinometer. The correlation between ultrasound and roentgenographic AV angles was high, indicating that reliable results were obtained by ultrasound. The preferred reference line was the head-trochanter tangent, which is recommended for clinical use. Consistently greater AV values were measured by ultrasound than by roentgenography. Thus, 10 degrees should be subtracted from the ultrasound values in order to obtain the real AV angles. One of the benefits of ultrasound is the elimination of radiation hazards to the patients. Ultrasound is recommended as a screening technique for patients with rotational disorders of the femur.
In a study of 40 young adults the pelvic inclination measured by a specially constructed inclinometer was found to be the same in the supine and standing positions when related to the horizontal and frontal planes, respectively. Consequently supine CT measurements of the hip are also representative of corresponding standing angles. The variations of the acetabular anterversion and the sector angles on CT of the hips in 5 adult corpses were measured by angulating the gantry in increments of 5 degrees to +/- 20 degrees. An approximate linear relationship was found for all parameters, the acetabular anteversion varied 0.5 degree with 1 degree pelvic rotation, and the sector angles 0.7 degree. A theoretic mathematical model for the variation of the acetabular anteversion outside the measured range employing a sine curve is introduced.
Renal artery stenosis may be the cause of hypertension and reduced renal function. The aim of surgical treatment is to eliminate or reduce the hypertension and to preserve or improve kidney function. At our hospital the standard surgical procedure is aortorenal bypass. We present the results of this procedure in the treatment of 23 patients (27 bypasses) during a five-year period. During the same periode nine patients were treated with percutaneous transluminal renal angioplasty. Arterial reconstruction of the renal artery is a relatively simple and cost-effective treatment. Furthermore, the rate of postoperative complications is low.
37 patients treated surgically for orbital blow-out fractures were reviewed retrospectively. 29 had diplopia before and four after operation. The diplopia was present only in extreme gaze positions and was not troublesome to the patients. Enophthalmus was present in 19 patients preoperatively and in six postoperatively. Of six patients treated conservatively one developed a moderate enophthalmus. There were no significant postoperative complications.
Idiopathic, benign, non-infectious, segmental, vertebral sclerosis is a self-limiting condition, which must be differentiated primarily from infectious spondylo-discitis and sclerosing vertebral metastases. The typical patient is a middle-aged, parous women with pain in the lower back region. Radiologically there is a characteristic half-dome shaped supradiscal sclerosis in the anterior and middle part of the affected vertebral body, which is always of normal height and there is never an abnormal paravertebral soft tissue mass. The erythrocyte sedimentation rate is normal. It is important to recognize this condition in order to avoid unnecessary examinations.
A case of teeth and jaw changes in primary hyperoxaluria is described. The patient, a 25-yr-old man, was treated by kidney transplantation twice, and finally by combined liver and kidney transplantation. The teeth and jaw changes consisted of deposition of oxalate crystals in the gingiva, in the pulp and in the vicinity of bone and dentin. The resorption of bone and dentin was extensive.