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At least 1,801 records · Page 100Linked to original sources
PubMed1990

Dislocation after total hip arthroplasty. Causes and prevention.

In this prospective study, a technique of positioning the acetabulum by bony landmarks of the pelvis in the standing position was developed using a standing lateral preoperative roentgenogram with the X-ray tube centered over the trochanter. Since 1984, 441 total hip arthroplasties (THAs) were done through the posterior approach with a 1.14% dislocation rate through 1988 and no dislocations in 1989. To prevent impingement and dislocation, it was determined that the safest range for cup position was 30 degrees-50 degrees abduction and 20 degrees-40 degrees flexion from the horizontal. To measure postoperative cup position, a standing true lateral roentgenogram of the operated hip allowed direct measurement of cup flexion and was reproducible within 10 degrees. No special instruments are necessary for this technique, which can be used with any THA system.

Female↗
PubMedDate not supplied

[Image distortions occurring on intraoral dental x-rays and the ways to overcome them].

Typical errors occurring in roentgenography of the teeth were simulated in a series of experiments. The results evidence that erroneous centering and angle of the x-ray tube inclination, incorrect centering of the film lead to disproportionate distortion of the shape, size, and position of all anatomical elements, that make the results of x-ray examination unreliable. Standardization of methods of intraoral roentgenography implies strict adherence to the rules of roentgenogram recording and treatment; this will permit obtaining high-quality roentgenograms and reduce the x-ray load of the patients.

Adult↗
PubMed1990

Detection of occult bone metastasis by MRI scan.

Back pain is a common complaint in patients with cancer. The standard diagnostic approach includes plain roentgenograms and radionuclide scans. We report two patients who presented with back pain and had unremarkable or equivocal roentgenograms and radionuclide scans. Their MRI scans demonstrated metastatic disease to the bone and spinal cord compression. The role is discussed of MRI scanning in patients with solid tumors and persistent back pain.

Carcinoma↗
PubMed1990

[Clinical study on asbestos pleurisy and review of literature].

Seven asbestos workers with asbestos pleurisy were investigated in terms of clinical symptoms, findings of pleural biopsies and course of chest roentgenograms. All cases were male and smokers. Duration of asbestos exposure ranged from 3 to 33 years (mean: 20.6 years). Duration between initial exposure and onset of the pleurisy ranged from 22 to 34 years (mean: 28.7 years). Five pleural effusions were aseptic and exudative, and one had sanguineus and eosinophilic effusion. According to the findings of pleural biopsies, our cases were classified into 2 groups. Group A (4 cases) had "basket-weaving formation" on the parietal side and inflammatory changes on the visceral side. No circulating autoantibodies were found in group A. Group B (3 cases) had no "basket-weaving formation" but only intensive inflammatory changes. These 3 cases were respectively complicated with anti-GBM antibody mediated glomerulonephritis, with acute interstitial pneumonia, and with rheumatoid arthritis and acute interstitial pneumonia. They all had circulating autoantibodies. In the course of chest roentgenograms, 6 of the 7 cases finally showed diffuse pleural thickenings which involved obliterations of costo-phrenic angles. Among them, one case developed into progressive pleural fibrosis. It was concluded that asbestos pleurisy can be classified into 2 groups according to the mechanism of occurrence, and immunological changes should be recognized as one of the mechanisms of asbestos pleurisy.

Adult↗
PubMed1990

Ligament injuries associated with tibial plateau fractures.

Thirty-nine patients with tibial plateau fractures and concomitant ligament injury were evaluated at least one year after injury. Ligamentous injury was determined by stress roentgenograms, plain roentgenograms, operative findings, and Pelle-grini-Stieda's ossification. There were 22 isolated medial collateral, eight lateral collateral, one isolated anterior cruciate, and eight combined ligament injuries. All types of tibial plateau fractures were associated with ligamentous injury, although split compression and local compression were most common. Twenty patients (Group 1) did not have operative repair of the injured ligaments, and 19 patients (Group 2) had primary repair of the injured ligaments. Open reduction and internal fixation of the plateau fracture(s) were performed in 13 patients in Group 1 and 19 patients in Group 2. Follow-up evaluation (100-point scale), including subjective, functional, and anatomic factors, revealed 12 excellent and good, four fair, and three poor results in the 19 patients with ligamentous repair. There were ten excellent and good, two fair, and eight poor results in those without ligament repair. Ten of the 12 patients with 10 degrees or more of instability had poor results. These poor results included five unrepaired medial collateral ligaments, two unrepaired lateral collateral ligaments, and three patients with cruciate ligament injury. This study confirms the view that instability is a major cause of unacceptable results in tibial plateau fractures. Operative repair of medial and lateral collateral ligaments, with appropriate treatment of the bony plateau fracture, may reduce late instability and may improve overall morbidity in these concomitant injuries. Cruciate ligament injury associated with a tibial plateau fracture carries a poor prognosis.

Adolescent↗
PubMed1990

Use of bipolar hip arthroplasty in states of acetabular deficiency.

Bipolar hip arthroplasty was performed on 557 hips from December 1980 to June 1988. The clinical results and serial roentgenograms of 37 hips with acetabular deficiency, treated by arthroplasty from December 1980 to June 1983, were followed for a minimum of five years. The longest follow-up period was seven years and six months after the operation. The clinical score was assessed by the hip rating score of the Japanese Orthopaedic Association, which assigns a maximum of 100 points. The preoperative clinical score ranged from 24 to 56 points (mean, 42.2 points). The postoperative score improved to a range of 71-100 points (mean, 82.7 points). Of 37 hips examined, 31 hips were pain-free. As measured from the serial roentgenograms after the operation, the overall distance of central migration of the prosthesis in 37 hips was 0-5 mm, with an average of 1.4 mm, two years after the operation. At the five-year follow-up evaluation, 27 of 37 hips showed no additional central migration. The overall distance of superior migration of the prosthesis in 37 hips was from 0 to 8 mm, with an average of 2.6 mm, two years after the operation. Additional superior migration was noticed in 18 of 37 hips (48.6%) at the time of this five-year follow-up evaluation.

Acetabulum↗
PubMed1990

Quantitative roentgenographic densitometry for assessing fracture healing.

A noninvasive method was developed to assess fracture healing using optical densitometric methodology. Photometric measurements of osseous tissue density were based on illuminance or intensity of light, transmitted through standard roentgenograms. The method was tested in 6-mm tibial segmental defects and single-cut osteotomy defects in adult mongrel dogs. The lowest measureable bone density in the defect was compared to bending rigidity of the involved extremity. For both types of defect, an exponential relationship was found between the densitometric evaluation of the healing fracture gap and bending rigidity. This method proved superior to a roentgenographic scoring method and is capable of detecting small differences in mineral content using standard roentgenograms. The high correlation between densitometric evaluation and bone rigidity indicates this method has potential for use in the in vivo assessment of fracture healing.

Absorptiometry, Photon↗
PubMed1990

The cocaine body-packer syndrome: evaluation of a method of contrast study of the bowel.

The questionable reliability of the conventional procedures for detection of ingested drug packages triggered us to evaluate the accuracy of a method of contrast study of the bowel in 23 nonsurgically managed cocaine body-packers. A single dose (60 mL) of a water-soluble contrast compound (amidotrizoate + meglumine) was given orally after initial clinical examination and drug detection in urine. Thereafter, roentgenograms were performed daily after spontaneous passage until obtaining two packet-free stools and negative views. Roentgenograms showed packages when performed at least 3 h after the ingestion of the contrast compound. Sensitivity and specificity of the method with respect to the detection of residual packets in the body, assessed by subsequent examination of stools, was good and did not diminish as the number of packages decreased during the time spent in ward. No side-effects were observed. We conclude that oral administration of a water-soluble contrast compound is an easily performed, efficient, and safe method for the nonsurgical management of cocaine body-packers.

Cocaine↗
PubMed1990

[Harlequin syndrome (unilateral flushing and sweating attack) due to a spinal invasion of the left apical lung cancer].

A 54-year-old man was admitted to our hospital because of a persistent pain of the left cervix and scapular region of three-month duration and an abnormal shadow in the chest roentgenograms. Neurological examinations, chest roentgenograms, chest CT scanning, vertebral tomograms and myelogram revealed Pancoast's syndrome concomitant with Horner's syndrome. Four months later, the patient complained of a sudden onset of unilateral flushing and sweating appearing on the right face, cervix and upper chest. Eye drop tests with cocaine, epinephrine and tyramine indicated the lesion of ciliospinal centers between the 8th cervical and 2nd thoracic spines. The unilateral flushing and sweating attack appearing on the intact side without Horner's syndrome seemed to be an excessive response by an intact sympathetic pathway, the other side failing to respond because of a sympathetic deficit.

Flushing↗
PubMed1990

Experimental tibial fractures in rabbits simulating proximal tibial metaphyseal fractures in children.

The etiology of valgus deformity after a seemingly innocuous fracture of the proximal tibial metaphysis in children is unknown. The purpose of this work was to identify the etiology of this deformity using a rabbit model. Twenty-two eight-week-old rabbits were divided into two groups. In Group I, the medial periosteum was excised from the left proximal tibial metaphysis. A partial osteotomy was created 5 mm distal to the epiphyseal plate, involving the medial one-half of the tibial metaphysis. Two 0.7-mm Kirschner wires were placed as markers on each side of the osteotomy. In Group II, the identical procedure was performed from the lateral side. Standard roentgenograms were obtained postoperatively and weekly until death by sodium pentobarbital overdose at six weeks. The angular deformity, medial growth, and lateral growth were calculated from the markers on the roentgenograms. All tibias were decalcified and analyzed under light microscopy. In Group I, all 11 rabbits developed valgus deformity averaging 12.2 degrees; asymmetric growth was statistically significant. In Group II, ten of 11 rabbits developed varus deformity averaging 9.8 degrees; asymmetric growth was not statistically significant. Despite obvious asymmetric growth in both groups, light microscopy failed to reveal any asymmetry of the physis. Valgus and varus deformities are secondary to asymmetric growth, which is not demonstrable by light microscopy.

Animals↗
PubMed1975

[Positive contrast arthrography in the diagnosis of ligament lesions in the upper ankle joint].

There are a great number of open questions in the diagnosis and the management of ligament lesions of the ankle joint. On the basis of the data of the literature and the author's experiences the advantages of the contrast arthrography of the ankle-joint may be resumed in the following: 1. No narcosis is necessary. 2. More exact determination of the site of the lesion is possible. 3. Therefore proper treatment may be chosen. 4. The incidental technical errors are more easily to be verified. (Paraarticular administration of the contrast medium is immediately demonstrable, whereas faulty observance of the prescriprions becomes not always evident from the roentgenogram). 5. No comparative roentgenograms are necessary. 6. The X-ray staff is not exposed to X-ray radiation.

Ankle Injuries↗
PubMed1989

Arthrography in the evaluation of congenital dislocation of the hip.

To assess the value of intraoperative arthrography, 48 preoperative hip arthrograms of 35 children under 18 months of age treated for congenital dysplasia of the hip were reviewed. The frequency of the common arthrographic observations was assessed and was compared with the findings observed from the plain roentgenograms, and with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the depth of reduction (medial dye column, 100%), the configuration of the osteocartilaginous structures (96%), and the presence of potentially obstructing soft tissue (limbus, 98%, and ligamentum teres, 78%). Arthrography was less reliable in discerning psoas contracture (36%), despite its presence at all open reductions. Arthrography proved reliable in outlining the inverted limbus that can obstruct closed reduction. Because ossification of the femoral head was frequently eccentric, the center edge (CE) angle of Wiberg was calculated from arthrography more accurately than from roentgenograms.

Acetabulum↗
PubMed1989

Cementless total hip arthroplasty using the anatomic medullary locking stem. Results using a survivorship analysis.

Three hundred forty-three primary hip arthroplasties performed prior to June 1984 were followed for two years, and an additional 204 were followed for five years. Anteroposterior and lateral roentgenograms taken at annual intervals were used for comparison. At two years, 78% of the hips showed roentgenographic signs of stem osseointegration. Seventeen percent were clinically stable but demonstrated reactive lines surrounding the porous surface, indicating lack of bone-ingrowth fixation. Four percent showed late implant migration. Using late migration as an end point, a survivorship analysis of the stem stability was performed. The cumulative survival rate for stable fixation was 94% at five years and 88% at eight years. Among the 143 undersized stems, 17 showed late migration and two failed by stem fracture at six and eight years, giving a cumulative survival rate of 77% at eight years. By contrast, there were no roentgenographic failures among 200 canal-filling stems. Three stems were revised: two for stem fracture and one for loosening with infection. Proximal stress shielding occurred only in bone-ingrowth stems and was slightly progressive. Unstable implants produced progressive intramedullary canal widening. The clinical results were superior when the roentgenograms showed signs of bone-ingrowth fixation. Functional recovery in such cases was equivalent to that for cemented arthroplasty.

Adolescent↗
PubMed1989

Indications and results of intertrochanteric osteotomy in osteonecrosis of the femoral head.

The intertrochanteric osteotomy has been used for several years as a method of treatment of osteonecrosis of the femoral head. As the clinical experience has increased, it has become apparent that, if the procedure is to succeed, specific criteria have to be met. In general, a valgus/flexion osteotomy should be done in patients younger than 40 years who have a Ficat Stage II and/or crescent sign. A necrosis angle of less than 200 degrees as measured on anteroposterior and lateral roentgenograms is also important in predicting a successful outcome. Caudal oblique roentgenograms also help determine the status of the posterior femoral head and whether the osteotomy is feasible. Preoperative planning is important to reduce operating time and obtain a good end result. A 95 degrees blade-plate is used, and if necessary, a small wedge is excised to ensure coaptation of the osteotomy segments. The results of the procedure in 17 patients show that eight patients have a satisfactory result at a mean of three years, while three patients continue to have problems. Five patients have been converted to total hip arthroplasties, and one has a girdlestone arthroplasty. The unsuccessful results occurred in patients who were on corticosteroids or had continued metabolic bone abnormalities. Present experience confirms reports of other series. The operation should be offered only to the small group of patients with idiopathic, posttraumatic, or alcohol-induced osteonecrosis of the femoral head.

Adult↗
PubMed1989

Bipolar implant shoulder arthroplasty. Long-term results.

The bipolar shoulder implant (BSI), designed by the senior author in 1975, has an unfixed metal glenoid cup with a polyethylene liner that articulates with a cemented titanium humeral component. The BSI was inserted in 35 shoulders of 33 patients with severe rheumatoid arthritis (20 cases), degenerative arthritis (ten cases), and posttraumatic lesions (five cases). The follow-up period ranged from 24 to 140 months (average, 63 months). Pain relief was good to excellent in 31 shoulders; four experienced some pain during daily activities. After BSI, motion was greatly improved with 71 degrees average range of abduction, 23 degrees range of adduction, 79 degrees range of flexion, 45 degrees range of extension, 76 degrees range of internal rotation, and 28 degrees range of external rotation. BSI was well-tolerated by the bone and soft tissues, with no erosive changes at the coracoacromial arch. There was no evidence of loosening at the cement-bone interface. One patient with a postoperative subcoracoid dislocation maintained a good functional result for more than 11 years. One BSI had draining sinus tract with negative culture, which spontaneously healed following removal of the implants. There were 3.3 mm (range, -7 mm to 11 mm) of superior subluxation of the humeral head on the preoperative roentgenogram. This increased to 8.7 mm (range, -5 mm to 20 mm) in the long-term follow-up roentgenogram. The bipolar implant is specially indicated in the severely arthritic shoulders in patients with vertical humeral subluxation and complicated histories of multiple failed operations.

Adult↗
PubMedDate not supplied

Application of clinical indicators in the emergency department.

Clinical indicators were developed and used to assess the quality of patient care resulting from the system of shared responsibility between emergency department (ED) and radiology department faculty physicians for interpretation of ED roentgenograms. The first indicator--all discrepancies in roentgenogram interpretation between ED and radiology department faculty--measured an overall discrepancy rate of 3.3% (776 films). Three hundred fifty-two apparent discrepancies were not related to the accuracy with which ED faculty interpreted films, resulting in a revised overall discrepancy rate of 1.8%. The second indicator--undesirable patient care outcomes as a result of delayed accurate radiological diagnosis--measured an occurrence rate of 0 after clinical reevaluation of more than 99% of patients within 24 hours of initial ED evaluation. Aspects of the development and use of clinical indicators are discussed in relationship to the broader monitoring and evaluating process necessary for the continuous improvement of patient care.

District of Columbia↗
PubMed1989

[A case of pulmonary lymphangiomyomatosis induced by pregnancy].

A 35-year-old primigravida was admitted to the Department of obstetrics complaining of dyspnea and left back pain at 21 weeks' gestation. Chest roentgenogram revealed diffuse reticulonodular shadows predominantly in both lower lung fields and arterial hypoxemia was present. Pulmonary function tests showed restrictive impairment and decreased carbon monoxide diffuse capacity. From these results, interstitial pneumonia was suspected and she was first treated with prednisolone. However during her pregnancy, spontaneous pneumothorax occurred. Following spontaneous delivery of healthy infant at 37 weeks, left chylothorax occurred, and pleurodesis was performed with OK432. Thereafter the histological diagnosis of pulmonary lymphangiomyomatosis was made by transbronchial lung biopsy and treatment of prednisolone was stopped. She was treated with tamoxifen. In addition, progesterone-receptor was detected in the pulmonary tissue obtained at open lung biopsy. She was treated with cyclophosphamide in addition to tamoxifen. At present, shortness of breath has decreased slightly in comparison with one year previously, but no improvement has been seen in lung function tests or chest roentgenogram.

Adult↗
PubMed1989

[A case of bromocriptine-induced interstitial pneumonitis in an iron factory worker exposed to sand dust].

A 62-year-old male, was admitted on Oct. 7, 1987 because of productive cough and dyspnea. He worked for an iron factory, where pneumoconiosis was regarded as an occupational disease, for 40 years. No abnormal finding had been noted on his mass screening chest roentgenograms. He was well until three years ago when hypertension and Parkinsonism were noted. Since then he was treated with beta blockers, L-DOPA, amantadine and bromocriptine. Two weeks before admission, he suddenly complained of dyspnea and productive cough. His chest roentgenograms showed diffuse reticulonodular infiltration in both lung fields. The partial pressure of oxygen of the arterial blood was 65.9 Torr. The first transbronchial lung biopsy obtained from right B8 on Sept. 29, 1987 (before the admission) revealed some epithelioid granulomas and the second biopsy obtained from right B10 on Oct. 14, 1987 demonstrated bronchiolar edema and infiltration of inflammatory cells. Fibrotic changes associated with carbon dust between airways and vessels were also noted. Lymphocyte stimulation index by bromocriptine was 362%, and that by amantadine, 139%, L-DOPA, 150%, respectively. After ceasing the administration of bromocriptine, productive cough, dyspnea and the reticulonodular shadows diminished gradually. These findings strongly suggest that the interstitial pulmonary lesions are bromocriptine-induced interstitial pneumonitis. His occupational exposure to inorganic dust may be a predisposing factor.

Bromocriptine↗

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