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Biomedical subjects

Y Floman

Publications and source records attributed to Y Floman.

At least 37 records · Page 2Linked to original sources
PubMed1996

The relationship between degenerative changes and osteoporosis in the lumbar spine.

Degenerative changes in the spine, specifically disc degeneration and facet arthrosis, and osteoporosis are conditions that primarily affect the elderly and may significantly impact the quality of life. The relationship between osteoporosis and degenerative changes in the hip joint has been studied, but their correlation in the spine is not entirely clear. Two hundred ninety-four subjects older than 50 years of age were retrospectively studied for the existence of lumbar spinal degeneration and osteoporosis through radiologic examination for 3 clinical manifestations: (1) disc degeneration, (2) facet joint arthrosis, and (3) lumbar osteoporosis. Peripheral osteoporosis in the distal radius of the nondominant hand was measured using a single-photon bone absorptiometer. Results indicated that subjects with severe osteoporosis in the distal radius also had severe degenerative changes in the discs and the facets; those with mild osteoporosis in the distal radius showed a tendency to have a lesser degree of degenerative changes than the subjects without osteoporosis.

Absorptiometry, Photon↗
PubMed1994

Prognostic factors in anterior decompression for metastatic cord compression. An analysis of results.

During the 10-year period 1981-1990, 59 patients suffering from spinal cord or cauda equina compression underwent anterior spinal decompression and in most cases spinal restabilization with methylmethacrylate cement and/or instrumentation. Follow-up in 55 patients showed that 75% were improved neurologically by the procedure, one-third of these showing complete recovery from the spinal cord compression. The results in younger female patients suffering from metastatic breast cancer were considerably better than those of older men with prostatic metastases. Other genitourinary system tumors also had a relatively poorer prognosis. There was a significantly better result for metastatic lesions of the thoracic or thoracolumbar spine than for lesions in the lumbar spine causing cauda equina paralysis.

Adult↗
PubMed1994

Hyperextension fracture-dislocation of the thoracic spine with paraplegia in a patient with diffuse idiopathic skeletal hyperostosis.

The case is described of a hyperextension thoracic spine fracture in a patient with diffuse idiopathic skeletal hyperostosis (DISH). A 70-year-old woman awoke paraplegic after retroperitoneal surgery after having been positioned in the hyperextended axially rotated position. Imaging demonstrated a T9-10 fracture-dislocation with severe pressure on the spinal cord, as well as findings typical of DISH. This case emphasizes the danger inherent in manipulating the ankylosed hyperostotic spine. It is proposed that patients undergoing surgery in this position should be evaluated for DISH as an additional risk factor.

Aged↗
PubMed1994

Acute postpartum inflammatory sacroiliitis. A report of four cases.

We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.

Acute Disease↗
PubMed1993

Overexertional lumbar and thoracic back pain among recruits: a prospective study of risk factors and treatment regimens.

A total of 395 male infantry recruits were evaluated in a prospective study of possible risk factors for overexertional back pain and the efficacy of drug treatment regimens for this syndrome. Recruits were classified into subgroups of lumbar or thoracic, and paraspinal or spinous process pain. Recruits were divided into three treatment groups: Ibuprofen, Paracetamol, and no drug treatment. Of the recruits, 18% were diagnosed as having overexertional back pain during the course of 14 weeks of training. By multivariate analysis low body mass index was found to be a risk factor for overexertional lumbar pain (p = 0.005) and increased lumbar lordosis a risk factor for overexertional thoracic pain (p = 0.005). Of recruits with overexertional back pain, 65% were asymptomatic by the end of basic training. There was no statistically significant difference between cure rates according to treatment groups.

Acetaminophen↗
PubMed1993

The logic of imaging in spine surgery.

Spinal imaging has rapidly evolved into a complex diagnostic field requiring specialized expertise. While many imaging modalities reveal portions of a topographic map of the spine necessary for surgery, only magnetic resonance imaging emerges as the imaging modality of widest and most efficacious first choice. With the increasing high-technology sophistication of modern imaging modalities, the spine surgeon must become completely conversant with the radiologic data produced by these imaging techniques. The authors present a logical approach to spinal imaging--an algorithm--based on etiologic classification and aimed at conserving medical resources and developing an optimal diagnostic pathway for spine injury and disease. Spine surgeons are urged to incorporate the interpretative insights of radiologists into the diagnostic process.

Algorithms↗
PubMed1993

Anterior vascularized rib strut graft in the treatment of Pott's disease in the young child.

Two young children suffering from acute thoracic kyphosis due to vertebral tuberculosis (Pott's disease) are described. One patient presented with recent onset spastic paraplegia due to cord compression. Anterior decompression and stabilization with a vascularized rib strut graft was performed in both patients. The neurological recovery in the compromised patient was remarkable; spinal stability was achieved in both patients, thus avoiding the necessity for a posterior spinal fusion.

Child, Preschool↗
PubMed1992

[Transoral approach to the lower clivus and upper cervical spine].

5 cases were operated via a transoral approach for basilar impression (2 cases), tumor (2), or traumatic dislocation of the odontoid process (1). In all except 1 there was compression of the lower medulla and/or upper cervical cord. Posterior cervical fusion was also performed in 2 patients. There was significant improvement in all the patients who presented with neurological deficits. Surgical morbidity was low and there was no mortality. The use of the operating microscope, microdrill, self-retaining mouth retractor, flexible oral endotracheal tube, and intraoperative fluoroscopy permit a safe, direct approach to the lower clivus and upper cervical region.

Child, Preschool↗
PubMed1991

CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures.

This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl--A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous--Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin.

Adult↗
PubMed1991

Effect of major axial skeleton trauma on preexisting lumbosacral spondylolisthesis.

The incidental occurrence of lumbar spine fractures in individuals with preexisting first degree lumbosacral isthmic spondylolisthesis may be looked upon as a simulated in vivo biomechanical experiment testing the stability of the lumbosacral subluxation. Among 200 patients with thoracolumbar spine fractures managed at the author's institution during the period of 1980-1989, five such cases were collected. All patients had a grade I isthmic spondylolisthesis at the L5-S1 level, and all sustained a burst fracture of the lumbar spine. In two patients, there was a previous history of low back pain and lumbosacral spondylolisthesis. In the other three patients, the olisthesis was judged to be old by a negative 99mTc-MDP bone scan, whereas the fractured vertebra showed intense uptake and/or by the negative operative findings at L5-S1 level during surgery. It was found that the incidence of lumbosacral spondylolisthesis in patients with thoracolumbar fractures was smaller than in the general population but the difference was not statistically significant (p = 0.213). In addition, it is concluded that mild lumbosacral spondylolisthesis can absorb considerable axial loading without an ascertainable evidence of damage.

Adult↗
PubMed1991

"Mirror image" congenital scoliosis in siblings.

Congenital scoliosis, which is caused by isolated anomalies (as opposed to multiple spinal anomalies and myelomeningocoele), is usually a nonfamilial condition. In rare instances, however, a congenital spine deformity is genetically determined. We herein report a brother and sister with a nearly identical "mirror image" congenital lumbar scoliosis. We conclude that the presence of a congenital spine deformity necessitates the screening of other siblings for a similar anomaly.

Adolescent↗
PubMed1991

Systemic mastocytosis presenting with severe spinal osteopenia and multiple compression fractures.

Systemic mastocytosis is a rare condition in which mast cells infiltrate various organs, including the skeleton. Because the mast cell secretes various bioactive substances that may induce bone resorption, this condition may cause generalized osteoporosis. We describe a case of a 28-year-old woman who presented with a painful thoracolumbar kyphosis due to generalized osteopenia and multiple pathological compression fractures and was found to have mastocytosis. She underwent operative stabilization of her kyphotic deformity with anterior interbody fusion and posterior Cotrel-Dubousset (CD) instrumentation and fusion. We conclude that mastocytosis should be suspected in an atypical case of so-called idiopathic osteoporosis.

Adult↗
PubMed1991

Transverse ligament rupture and atlanto-axial subluxation in children.

We report four children aged two to nine years with traumatic tears of the transverse ligament of the atlas and atlanto-axial subluxation. This is extremely rare in this age group since trauma usually causes a skeletal rather than a ligamentous injury. The injuries resulted from falls or motor vehicle accidents, with considerable delay in diagnosis. Flexion radiographs showed atlas-dens intervals (ADI) of 6, 7, 8 and 13 mm; all four patients were treated by posterior fusion at C1-C2 after the failure of conservative treatment. In one child with quadriparesis and a fixed ADI of 13 mm, transoral anterior resection of the odontoid was performed before the fusion. Diagnosis of this traumatic lesion requires a high level of suspicion. Conservative treatment is likely to fail; surgical stabilisation is indicated.

Atlanto-Axial Joint↗
PubMed1991

Pyogenic vertebral osteomyelitis with paralysis. Prognosis and treatment.

In the interval between 1983 and 1988, 14 patients were treated for pyogenic spondylitis complicated by neurologic compromise. There were nine males and five females aged 39-80 years. The average time between onset of symptoms and diagnosis was 2.8 months. Predisposing factors were diabetes mellitus in four patients and urinary tract infections in five patients. The infection was blood borne in all 14 patients. In two patients, the infection was superimposed on a recent vertebral fracture. The cervical spine was involved in one patient; the thoracic spine in seven; and the lumbar spine in six patients. Six patients presented with a Frankel B paralysis, six with a Frankel C paralysis, and two with grade D paralysis. The neurologic symptoms lasted between one day and six weeks before surgery. Twelve patients had anterolateral decompression. Two of the 12 patients had a second stage posterior stabilization. Two patients were deemed inoperable. All surviving patients were managed by parenteral antibiotics for three to six weeks followed by enteral route for a total of three to six months. All 12 operated patients had a significant neurologic improvement (one grade or more on the Frankel scale) with solid interbody fusion.

Adult↗
PubMed1990

Secondary prevention of low-back pain. A clinical trial.

A clinical trial, aimed at secondary prevention of low-back pain, was performed in 142 hospital employees reporting at least three annual episodes of this condition. Participants were randomly assigned to one of three groups: a calisthenics program (CAL) for 3 months with biweekly sessions of flexion exercises, a back school program (5 sessions), and a control group. The effectiveness of the two intervention programs was evaluated over a 1-year period. Baseline preintervention data and evaluation at the end of 3 months of intervention and after an additional 6 months were collected. A monthly surveillance for the whole year showed a mean of 4.5 "painful months" in the CAL group versus 7.3 and 7.4 months in the back school and control groups, respectively (P less than 0.0001). The superiority of the CAL group was achieved partly because of the significant increase in trunk forward flexion and to initial increment in abdominal muscle strength. The increased trunk flexion was associated with the rate of participation in the CAL sessions. Further research is needed to answer the question of "intensity versus type of exercise" by comparing different intervention programs, with similar intensity.

Back Pain↗
PubMed1989

[Cauda equina syndrome in lumbar disc herniation].

During the past 5 years 10 patients suffering from cauda equina syndrome as a result of prolapsed disc were treated surgically. Although considerable time had elapsed between the onset of symptoms and the operation, most of the patients improved, at least partially. The syndrome is a rare complication of a common condition of the lower spine. Awareness of its possibility and identification of the early clinical picture are essential. An accurate history and detailed physical examination are the most important factors in early diagnosis. In 5 women and 4 men, who ranged in age from 28-60 and averaged 41 years, the disks involved were L5-S1 in 6, L4-L5 in 2 and L1-T12 in 1 case. Persistent disability was found in most of the patients, including 4 with bladder and 4 with sexual dysfunction. In 7 there was residual sensory loss and in 5 some degree of motor weakness. Earlier surgical treatment seems to be the most effective method for improving the results of treatment.

Adult↗
PubMed1989

Altered structural and functional properties of myosins, from platelets of idiopathic scoliosis patients.

Platelets of patients with idiopathic scoliosis (IS) have been shown to have decreased capacity to aggregate and secrete in response to certain agonists. Similarities between the contractile protein system of platelets and muscle have made the platelets a popular model for muscle disease. We attempted to characterize the function and structure of myosin in platelets of IS patients. Blood was obtained from seven IS patients and seven matched non-scoliotic healthy controls. The mean Cobb angle measurement of the IS patients was 35.4 degrees with a mean Risser sign of 2.2. Washed platelets were isolated from the blood, and the contractile proteins from the membrane and the cytosol compartments were isolated and analyzed by two-dimensional peptide mapping. As previously reported (J Biol Chem 258:9290, 1983), peptide maps of normal platelets revealed that the heavy chain of myosin located in the platelet membrane lacks one major spot relative to the cytoplasmic myosin. In IS patients the cytoplasmic myosin lacks the same peptide that is missing in the membrane myosin of normal individuals. In addition, the ATPase specific activity of the cytoplasmic myosin from IS platelets was significantly lower compared with the activity of the cytoplasmic myosin from normal platelets. These results suggest the presence of a fundamental abnormality of IS platelet contractile proteins.

Adenosine Triphosphatases↗