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At least 613 records · Page 34Linked to original sources
PubMed1984

Composite autogeneic human cranioplasty: frozen skull supplemented with fresh iliac corticocancellous bone.

Skull totally exteriorized during craniotomy becomes nonviable. Resorption of the reimplanted cranial section occurs variably according to its treatment, the properties of the recipient bed, and the metabolic conditions of the host. Neurosurgeons commonly deep freeze autogeneic skull for preservation before delayed autogeneic cranioplasty. Aseptic necrosis commonly follows replacement of the autograft in its former cranial bed. This clinical study of six patients represents an attempt to block this destructive resorption by supplementing the frozen autograft with fresh corticocancellous autogeneic ilium. Observations of these patients ranging in age from 12 to 52 years support the following conclusions: (a) Osteogenesis was not enhanced by the addition of fresh corticocancellous bone to the frozen autoimplant. (b) The period of time that the autoimplant was frozen did not influence its subsequent biological behavior after cranioplasty. (c) Sterilization with ethylene oxide and in one case additional gamma irradiation did not impair the quality of the implant compared to those not sterilized. (d) Resorption occurred in both frozen and fresh but devitalized autogeneic skull. (e) Autogeneic skull is repaired by osteoconduction rather than by inducing competent perivascular stem cells to become osteogenic. (f) Freezing of autogeneic skull for preservation is practical, acceptable, but suboptimal from the perspectives of cerebral protection and cosmetic reconstruction. (g) The supplementation of the frozen autoimplant with fresh corticocancellous bone increases operating time and patient discomfort without affording additional benefit.

Adult↗
PubMed1984

Intradural spinal metastasis in Ewing's sarcoma: case report and review of the literature.

Ewing's sarcoma is a rare primary osseous neoplasm of children and young adults. The use of radiotherapy and adjuvant chemotherapy has favorably influenced the outcome of patients and dramatically reduced the rate of local disease recurrence. However, distant metastasis, usually to the lung and skeletal system, continues to be a frequent preterminal event. Metastasis to the central nervous system is infrequent unless related to adjacent bone involvement. We report a case of intraneural, intradural metastasis in a young man with a previously treated Ewing's sarcoma of the ilium. Metastasis to this part of the nervous system has not been previously reported.

Adolescent↗
PubMedDate not supplied

Agenesis of bilateral iliac bone. A case report.

In a boy one year eight months of age, absence of the entire ilium was associated with spinal and rib anomalies. The ischium and pubis were present. Arthrograms of the hip joint revealed a normal configuration of the femoral head with the joint capsule attached proximally to the ischium and pubis.

Abnormalities, Multiple↗
PubMed1983

Congenital pseudarthrosis of the tibia. Three cases treated by free vascularized iliac crest graft.

Three patients with congenital pseudarthrosis of the tibia were successfully treated by free microvascularized iliac crest grafts. All three patients had had two unsuccessful internal fixation reconstruction operations. Union occurred rapidly between the resected bone ends and the vascularized bone graft. Although the fibula has more often been used as a vascularized free graft, the ilium is a better source of bone for bridging small gaps.

Adolescent↗
PubMedDate not supplied

Modification of the anterior iliofemoral approach to the hip.

This paper describes a modified iliofemoral surgical approach to the hip joint performed on 282 patients over a 26-year period. The surgical technique follows the anterior iliofemoral approach except that the lateral "bone overhang" of the iliac crest is osteotomized and dissected distally with the fascia lata to expose the hip capsule. The "six muscle glove" is sharply dissected off the greater trochanter, the hip capsule is opened and surgery is carried out, upon completion of which the operated leg is abducted. The osteotomized iliac crest bone-graft with the attached muscles is reapproximated to its anatomical position and fixed with permanent sutures through five holes drilled through the replaced bone graft and the intact ilium. The closure is rapidly performed, strong, and allows early functional return. Blood loss is relatively slight.

Adult↗
PubMed1982

A new orthopedic fixation method in the treatment of bladder extrophy.

Extreme diastasis of the pubis and malalignment of both ilium and hip joints are always associated with the absence of infraumbilical structures and with the failure of the anterior bladder wall to close. Therefore, for a successful cure of extrophy, the pelvic ring has to be repaired, at the time of or a few days prior to the surgical cure of the bladder. The repair of the pelvis, when executed in poor aseptic conditions, results in difficult nursing problems, and fails due to the lack of convenient fixation. For these reasons, we transformed Bartons tongues into an external fixator which enhanced and improved the controlled contention of the "vertical bilateral posterior osteotomy" of the pelvis. When a two stage procedure is decided on, the modified Bartons tongues do not interfere with the urologic surgery, and in addition, the nursing problems are alleviated. Although we have used our modified Bartons tongues in only three cases, our methodology is of low enough risk for it to be reported at this time.

Bladder Exstrophy↗
PubMed1980

A reappraisal of the anatomy of the human lumbar erector spinae.

In the lumbar region the longissimus thoracis and iliocostalis lumborum are separated by the erector spinae aponeurosis and its ventral reflection--the lumbar intermuscular aponeurosis. Lumbar fibres of the longissimus arise from the ilium and the lumbar intermuscular aponeurosis and insert into the accessory processes and proximal ends of the transverse processes of the lumbar vertebrae. Lumbar fibres of iliocostalis insert into the costal elements of the first four lumbar vertebrae. The lumbar insertions of these muscles are homologous to their thoracic insertions. The lumbar intermuscular aponeurosis is homologous to the lumbar intermuscular septum in the dog, cat and monkey. The details of attachment of the lumbar fibres of the erector spinae and of the lumbar intermuscular aponeurosis should be taken into account in biomechanical analyses of the lumbar vertebral column.

Adult↗
PubMedDate not supplied

The presence of lining cells on surfaces of human trabecular bone.

Sixteen human trabecular bone biopsies were obtained from sites located in the ilium and in the area of the greater trochanter of the femur. Patients ranged from 19 to 85 years old and included men and women. All bone surfaces observed contained osteoid. Flat, branched fibroblastic-like cells were observed lining bone surfaces in all biopsy specimens. The presence of these cells was not dependent on age, sex, race, or disease state of the patient. Based on this study, we believe that the majority of human trabecular bone surfaces are covered with these thin lining cells.

Adult↗
PubMed1980

The Chiari pelvic sliding osteotomy.

The Chiari pelvic osteotomy deserves better than the rather damning description of "salvage procedure." Although it cannot be regarded as a physiologic reconstructive procedure because hyaline articular cartilage is not brought over the femoral head, it nvertheless has unique advantages and specific indications. The procedure is entirely extra-articular, and the tissue (largely new bone) that forms between the displaced ilium above and the capsule of the joint below has the capability of adapting to irregularities in the femoral head. This provides the operation with flexibility of application and it may be used when acetabular rotation procedures are contraindicated. It is most effective in containing coxa magna and the moderately distorted, exposed femoral head. Because it success does not depend upon the shape of the acetabulum, it finds a further important role in containing the femoral head in conditions of acetabular dysplasia. The Chiari pelvic osteotomy must be performed accurately and with due care. When applied correctly, it has specific and important roles in the management of many difficult conditions of the hip joint.

Acetabulum↗
PubMed1994

[Paget disease, complicated by Ki-1 lymphoma with G-CSF growth factor secretion].

Development of lysis within an area of pagetic bone suggests a sarcoma. We report the case of a 61-year-old woman who had increasingly severe pain in her right hip and a decline in general health. The roentgenogram of the pelvis showed previously known pagetic lesions of the right half of the pelvis and osteolysis of the roof of the acetabulum. Additional imaging studies (ultrasonography, computed tomography, and magnetic resonance imaging) disclosed a pelvic tumor extending on either side of the right ilium. The peripheral white blood cell count was markedly elevated (93,000/mm3) as a result of inappropriate secretion of granulocyte-colony-stimulating factor. The tumor was an anaplastic large cell lymphoma of T-cell origin with CD30 positivity, i.e., a Ki-1 lymphoma. Most CD30-positive lymphomas are high-grade tumors. There has been only one previous report of Ki-1 lymphoma with production of granulocyte-colony-stimulating factor and hyperleukocytosis. It has been suggested that cytokines may influence tumor growth. Unusual features in our case include development of the Ki-1 lymphoma in an area of pagetic bone and presence of a leukemic syndrome due to increased production of a growth factor.

Bone Neoplasms↗
PubMed1976

Repair of the spondylolisthetic defect and intertransverse fusion for young patients.

A technique, applicable to young patients with mild to moderate symptoms from a pars defect is described. It is based on the concept that bone grafting of the pseudoarthrosis and an intertransverse fusion using small fesh autogenous concellous grafts from the ilium will prevent further slip. Gratifying results have been obtained in 12 patients, 12 to 18 years of age, with a minimum follow-up of 12 months. The pars defect in all patients healed in 6 months, with a short period of hospitalization and applying a lumbosacral corset as the only means of postoperative immobilization in 7 patients. In 5 patients with a concomitant scoliosis, 3 of whom were surgically treated, the Milwaukee brace was used for immobilization.

Adolescent↗
PubMed1995

Identification of an unknown corpse by means of computed tomography (CT) of the lumbar spine.

For the first time, a case is described in which an unknown corpse is identified by the comparison of antemortem and postmortem computed tomographic (CT) images. A posterolateral disc herniation at L5-S1 on the right side, Schmorl's nodes and a lucency in the ilium were found in identical locations in each case. Additionally there were characteristic morphological similarities in the vertebral bodies, spinous processes, transverse processes and neural arches. In CT identification, as in conventional radiographic identification, one must try to reproduce comparable scanning conditions and images because apparent differences in the roentgenological morphology can occur as a result of different gantry angles or slice thicknesses.

Expert Testimony↗
PubMed1994

Incidental finding of a hepatic lesion: differential diagnostic problems for fibrolamellar hepatic carcinoma.

We report the case of a 39-yr-old female with a liver lesion that was incidentally detected by ultrasound. Examination of biopsy specimens revealed focal nodular hyperplasia. A metastatic tumor in the right os ilium developed in the following weeks and showed specific uptake of 99mTc-hepatic 2,6-dimethyliminodiacetic acid (HIDA), suggesting metastasis from a differentiated hepatocellular carcinoma. The final pathologic diagnosis was multifocal, solid and glandular hepatocellular carcinoma, partly differentiated as fibrolamellar carcinoma, and an osseous metastasis from the differentiated hepatocellular carcinoma.

Adult↗
PubMed1993

Osteopetrosis. Current clinical considerations.

Osteopetrosis is an inherited skeletal condition characterized by increased bone radiodensity. There are three clinical groups: infantile-malignant autosomal recessive, fatal within the first few years of life (in the absence of effective therapy); intermediate autosomal recessive, appears during the first decade of life but does not follow a malignant course; and autosomal dominant, with full-life expectancy but many orthopaedic problems. The infantile variant shows a myelophthisic anemia, granulocytopenia, and thrombocytopenia, and patients eventually die from infection or bleeding or both. Neurologic sequelae include cranial nerve compression (optic nerve, blindness; auditory nerve, deafness; facial nerve, paresis), hydrocephalus, convulsions, and mental retardation. Radiographs show uniform bone density without corticomedulary demarcation, broadened metaphyses, "bone within a bone" or endobone phenomena (tarsals, carpals, phalanges, vertebra, ilium), and thickened growth plates if there is superimposed rickets. Transverse pathologic fractures occur, often followed by massive periosteal bone formation. Computed tomographic scans, magnetic resonance imaging, and bone scans provide specific information. Iliac crest bone biopsy is valuable to quantitate osteoclast and marrow changes by light and electron microscopy. Medical treatments involve high-dose calcitriol to stimulate osteoclast differentiation and bone marrow transplantation to provide monocytic osteoclast precursors. Orthopaedic problems in the intermediate and autosomal dominant forms include increased fractures, coxa vara, long-bone bowing, hip and knee degenerative arthritis, and mandibular and long-bone osteomyelitis. Cranial nerve compression also occurs. Osteotomy, plating, intramedullary rodding, and joint arthroplasty can be done, but are difficult because of bone hardness.

Anemia, Myelophthisic↗
PubMed1993

[Results of dorsal pelvic ring stabilization].

Complete disruptions of the posterior pelvic ring are rotationally and vertically unstable [type C according to the Tile/AO (ASIF) classification (1991)]. Usually operative treatment is required. The data on 24 patients over a 5-year period were analyzed. Thirteen patients were female (54.2%) and 11 male (45.8%); the average age was 32.8 years. Multiple trauma was present in 20 patients (83.3%). In most cases operative stabilization of the posterior pelvic ring was performed by lag screws from the ilium into the body of the sacrum. The mortality in this series was 16.7% (4 patients). One patient had a thrombosis of the femoral and pelvic veins. In 2 patients we had to perform a second operative procedure because of lag screws that had not been precisely placed or had dislocated. Two incisions healed secondarily. On the postoperative radiographs in 3 patients a slight deformity of the pelvic ring was visible; in another patient the reduction of the injured hemipelvis was not sufficient. The 20 survivors had a clinical and radiological examination on average 27.5 months after their injury. Eleven patients were without pain, while 9 complained of low back pain. Gait disturbances were found in 8 patients; in 2 of them this was due to associated injuries. Five patients were unable to work. Eight patients had neurological deficits, some of them minor. Additional complications were impotence (3 patients), urinary (2 patients) or fecal incontinence (1 patient), and dystocia requiring a cesarean section (1 woman) [multiple entries].(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Indications and results of vascularized pedicle iliac bone graft in avascular necrosis of the femoral head.

Several reports describe methods of treatment for avascular necrosis of the femoral head (ANFH) involving 0 to 2 mm of collapse. Some cases of ANFH have good prognoses, requiring only non-weight-bearing treatment. Other cases rapidly progress to collapse and complete destruction with enlargement of the necrotic area. The progression of the necrotic area is related to the activity of the original disease, steroid treatment, and the size and location of the necrotic area in the early stages of the disorder. In this report, a vascularized pedicle bone graft was used to treat ANFH, particularly those cases identified as Stage II on the system established by the Japanese Investigation Committee. Surgery involved curettage of necrotic bone, implantation of spongy bone, and application of a vascularized pedicle bone graft. Grafts were taken from the ilium and included the superficial circumflex iliac artery (SCIA). A bony canal was made in the anterior femoral neck, from which the necrotic bone was curetted and to which the bone graft was applied. The deep circumflex iliac artery (DCIA) was also used in combination with the SCIA. The postoperative weight-bearing period was six months. Follow-up periods lasted one to six years. Seventeen of 23 Stage II joints (19 cases) achieved satisfactory results at a mean of three years after surgery. Three Stage II joints and three Stage III joints continue to have significant problems. One of these six has been converted to a dual-bearing type endoprosthesis. The unsuccessful results generally occurred in patients who were treated with steroids.

Adult↗