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Biomedical subjects

W W Ginsburg

Publications and source records attributed to W W Ginsburg.

At least 19 recordsLinked to original sources
PubMed1997

Posterior vertebral body erosion by arachnoid diverticula in cauda equina syndrome: an unusual manifestation of ankylosing spondylitis.

Cauda equina syndrome is an uncommon complication of longstanding ankylosing spondylitis. It is associated with dorsal arachnoid diverticula, which may erode the lamina and spinous processes of the bony lumbosacral spine. We describe a patient who developed cauda equina syndrome associated with the unusual finding of erosion of the posterior aspect of 2 vertebral bodies by arachnoid diverticula. This was clearly revealed by magnetic resonance imaging of the spine.

Aged↗
PubMed1992

Clinically occult avascular necrosis of the hip: prevalence in an asymptomatic population at risk.

An abbreviated screening magnetic resonance (MR) imaging examination was used to determine the prevalence of clinically occult avascular necrosis (AVN) of the hip in 100 asymptomatic renal transplantation patients treated with corticosteroids. All patients were more than 18 years old, had been treated with corticosteroids for at least 6 months, and had no symptoms of AVN before MR imaging. Of the 100 patients screened, six were found to have clinically occult AVN at MR imaging (rate: 6%, with a 95% confidence interval of 2.2%-12.6%). No significant differences were found regarding the total dose of corticosteroids and exposure time between patients with and patients without asymptomatic AVN. The authors conclude that there is a significant prevalence of asymptomatic, clinically occult AVN among renal transplantation patients treated with corticosteroids and that a potentially low-cost screening MR imaging examination can be used to detect such disease.

Female↗
PubMed1992

Atypical eosinophilic fasciitis localized to the hands and feet: a report of four cases.

We describe 4 patients who had episodic localized swelling of an extremity, 2 of the hand and 2 of the foot, in combination with peripheral eosinophilia and a biopsy characteristic of eosinophilic fasciitis (EF). Surgical excision produced marked improvement in the patients' symptoms. Whether these patients, despite a characteristic biopsy, can be included in the spectrum of EF remains uncertain.

Adult↗
PubMed1991

Sacral insufficiency fractures: an often unsuspected cause of low back pain.

We describe a patient with sacral insufficiency fractures presenting as acute onset low back pain without antecedent trauma. Sacral insufficiency fractures are an often unsuspected cause of low back pain. The clinical presentation and plain radiograph findings can mimic metastatic disease, leading to unnecessary investigations and treatment. However, the location, linearity, and appearance of these fractures on computed tomography is very characteristic and obviates the need for further evaluation.

Aged↗
PubMed1990

Polymyalgia rheumatica.

Polymyalgia rheumatica is a syndrome that occurs in the elderly and is characterized by pain and stiffness involving the neck, the shoulder girdle, and the hip girdle. The aching should be present for greater than one month. Polymyalgia rheumatica may be more common than reported. The etiology remains unknown. There is generally little found pathologically in this disease. The physical examination is often not impressive. Synovitis may be a main contributing factor to many of the symptoms seen in patients with polymyalgia rheumatica. Symptoms often do not correlate with physical findings. Polymyalgia rheumatica must be differentiated from many conditions since the diagnosis remains entirely clinical. Osteoarthritis, flu syndromes, inflammatory myopathies, fibromyalgia, and depression all have features that may mimic polymyalgia rheumatica. Malignancies and infections may also be difficult to separate from polymyalgia rheumatica. Polymyalgia rheumatica may also be extremely difficult to differentiate from seronegative rheumatoid arthritis in patients older than 50 years. Although some patients with polymyalgia rheumatica have underlying giant cell arteritis, the majority apparently do not. The distinction between polymyalgia rheumatica and giant cell arteritis cannot be made on the basis of laboratory studies and relies solely on clinical symptoms and physical findings. Although nonsteroidal antiinflammatory medications may control symptoms in patients with mild disease, most patients with polymyalgia rheumatica require low-dose corticosteroids. The tapering schedule for the corticosteroids is contingent upon the response of symptoms and laboratory parameters. Polymyalgia rheumatica usually follows a benign course with almost complete response to an adequate treatment program. Recently, there have been several studies suggesting that the course of polymyalgia rheumatica may not be as short and simple as once proposed. Nevertheless, many patients may be completely weaned from corticosteroids. Other agents have been used in this disease, but for the most part their use remains somewhat controversial. Patients must be monitored carefully. Most patients do well, and treatment is effective.

Aged↗
PubMed1989

Multicentric reticulohistiocytosis: response to alkylating agents in six patients.

STUDY OBJECTIVE: To determine the efficacy of alkylating agents in multicentric reticulohistiocytosis. DESIGN: Open consecutive case series. SETTING: Tertiary-care referral clinic. PATIENTS: Six patients with skin-biopsy-proven multicentric reticulohistiocytosis. All had skin nodules and polyarthritis. INTERVENTION: Five patients received cyclophosphamide (dose range, 1.25 to 2.2 mg/kg body weight) and one patient received chlorambucil (0.1 mg/kg). Therapy was administered from 6 to 24 months. MEASUREMENTS AND MAIN RESULTS: In five patients treated with cyclophosphamide a response was seen within 4 months. Four patients eventually had a complete remission and one had almost a complete remission. The four patients in complete remission had cyclophosphamide therapy discontinued after 6, 12, 16, and 18 months. Three of the four patients remained in complete remission off therapy at 6, 6, and 22 months, whereas one had a recurrence after 6 months. The one patient given chlorambucil went into a complete remission and stopped treatment after 12 months. He remained in complete remission 32 months after stopping medication. CONCLUSION: Our experience with patients with aggressive multicentric reticulohistiocytosis shows that alkylation therapy is warranted. We conclude that a response to an alkylating agent may be expected. Whether after treatment for 6 to 18 months most patients may be able to discontinue the drug and remain in remission has yet to be shown. The rarity of multicentric reticulohistiocytosis precludes the possibility of a double-blind study.

Adult↗
PubMed1989

Eosinophilic fasciitis.

The fascia had received little attention until Shulman's delineation of EF. Evidence is now accumulating that in addition to EF and scleroderma, significant fascial inflammation may be seen in polymyositis, dermatomyositis, eosinophilic polymyositis, systemic lupus erythematosus, and mixed connective tissue disease. It is still unclear whether EF represents a variant of scleroderma; however, it is becoming increasingly recognized that scleroderma shares many features in common with EF including eosinophilia, hypergammaglobulinemia, positive ANA and rheumatoid factor, and an association with hematologic disease. The rarity of Raynaud's phenomenon and significant visceral changes help distinguish EF from systemic scleroderma. In this regard, however, EF more closely resembles the localized scleroderma syndromes, especially morphea profunda and pansclerotic morphea. Biopsy in EF, systemic scleroderma, and localized scleroderma will show comparable changes, the essential difference being the levels at which they occur.

Eosinophilia↗
PubMed1988

Eosinophilic fasciitis: clinical spectrum and therapeutic response in 52 cases.

The clinical course of 52 cases with eosinophilic fasciitis observed at the Mayo Clinic has been described. Cutaneous changes included pitting edema, peau d'orange, and induration, and may affect virtually any body surface area. In addition, localized morphea was present in 15 cases. Arthritis was observed in 21 patients; 29 patients had flexion contractures and 12 had carpal tunnel syndrome. Associated hematologic diseases were found in five patients; thrombocytopenia in two, myeloproliferative disorder in one, myelomonocytic leukemia in one, and chronic lymphocytic leukemia in one. Peripheral blood eosinophilia was noted in 33 of 52 patients, hypergammaglobulinemia was noted in 17 of 49, and elevated sedimentation rate was noted in 15 of 52. Nonspecific EMG changes were seen in 11 of 15 patients. None had clinical involvement of the kidneys, lungs, or heart. No significant association between any HLA-A, -B, or -DR and eosinophilic fasciitis was seen. Prednisone and hydroxychloroquine seemed equally beneficial in treatment; however, some cases showed spontaneous recovery, making evaluation of therapeutic efficacy difficult. Relapses occurred in some cases.

Adolescent↗
PubMed1988

The varied clinical manifestations of iliopsoas bursitis.

Iliopsoas bursitis is often overlooked as the cause of symptoms involving the inguinal area and lower extremity. We report 8 patients with iliopsoas bursitis. All had either osteoarthritis or rheumatoid arthritis of the hip but only 3 had significant hip pain. Patients presented with an inguinal mass and hip pain (2); unilateral leg swelling (2); inguinal mass and unilateral leg swelling (1); hip pain (1); pelvic mass with bladder compression (1); and no symptoms (1). The diagnosis was entertained initially in only 2 patients. Computed tomography was useful in establishing the diagnosis.

Aged↗
PubMed1987

Transient regional osteoporosis. A study of 56 cases and review of the literature.

We describe the clinical features and course of disease in 56 patients (33 men and 23 women) with transient regional osteoporosis. The median age at hospitalization was 48 years. All patients had monoarticular or oligoarticular joint pain that was aggravated by weight bearing. Eighteen also had pain at rest in the involved joints and 6 had nocturnal pain. The joints of the lower extremities were affected in 54 patients; the hip was the most commonly affected joint. There was little evidence of synovitis. Osteoporosis was diagnosed on the basis of characteristic clinical findings and the results of roentgenograms and bone scans. The osteoporosis resolved spontaneously over several months. Treatment consisted of joint protection, initiation of gradual ambulation, and administration of nonsteroidal anti-inflammatory agents. Although its cause is unknown, osteoporosis appears to be a regional rather than a systemic process.

Adult↗
PubMed1987

Tuberculous fasciitis with tenosynovitis.

A case of tuberculous fasciitis with tenosynovitis is described. No other organs were affected and tissue histology was not diagnostic. The diagnosis was confirmed by tissue culture and our patient was treated by surgical debridement and antituberculous drug therapy. A high index of suspicion for tuberculosis will alert clinicians to the correct diagnosis in unusual clinical presentations.

Fascia↗
PubMed1986

How lupoid is lupoid hepatitis?

The records of 89 patients with hepatitis B surface antigen, negative severe chronic active hepatitis and antinuclear antibody (ANA) positivity were reviewed to assess the degree of clinical similarity between this disorder and systemic lupus erythematosus (SLE). Although immunologic abnormalities, such as antibodies to native DNA and positive lupus erythematosus cell preparations were common, few patients with ANA positive chronic active hepatitis had clinical features to suggest SLE. The 1971 preliminary criteria and the 1982 revision of the American Rheumatism Association criteria for classification of SLE were 93 and 91% specific, respectively. We conclude that despite laboratory similarities, ANA positive chronic active hepatitis and SLE differ substantially in their clinical presentations.

Adolescent↗
PubMed1985

Seronegative polyarthritis in giant cell arteritis.

Nineteen of 520 patients with biopsy-proven giant cell arteritis were found to have persistent seronegative, symmetric polyarthritis with a mean joint count of 20 (swollen plus tender). In 9 patients in the onset of polyarthritis occurred prior to the diagnosis of giant cell arteritis, 3 had simultaneous onset, and 7 developed polyarthritis within 3 years after the onset of giant cell arteritis. Ten of the 19 patients demonstrated radiographic features of joint space narrowing and/or erosions. In 1 patient in a synovial biopsy was performed, revealing marked multinucleated giant cell infiltration. A persistent seronegative polyarthritis, although uncommon in giant cell arteritis, may be its presenting symptom. Other symptoms of giant cell arteritis should be sought in patients who exhibit this feature, especially in those whose arthritis begins at age 50 or older.

Aged↗
PubMed1984

Mitral stenosis associated with valvular tophi.

Chronic tophaceous gout has become less common since the introduction of allopurinol and probenecid. Cardiac tophi have rarely been reported. In this article, we report a case of severe mitral stenosis in which valvular tophi played a major role in the pathogenesis. The case was well substantiated by echocardiography, surgical pathology, and chemical analysis.

Aged↗