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At least 829 records · Page 46Linked to original sources
PubMed2000

Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain.

OBJECTIVE: To assess the intraexaminer and interexaminer reliability of a multidimensional spinal diagnostic method commonly used by chiropractors. DESIGN: An intraexaminer and interexaminer Latin square, repeated measures reliability study. The techniques of diagnosis under investigation included visual postural analysis, pain description by the patient, plain static erect x-ray film of the lumbar spine, leg length discrepancy, neurologic tests, motion palpation, static palpation, and orthopedic tests. PARTICIPANTS: Three experienced chiropractors examined 19 patients, and 2 experienced chiropractors examined 10 and 9 patients, respectively, who were suffering from chronic mechanical low-back pain. RESULTS: Intraexaminer reliability of the decision to manipulate a certain spinal segmental level was moderate (kappa = 0.47). The interexaminer agreement pooled across all spinal joints indicated fair agreement (kappa = 0.27). Interexaminer reliability for individual examiner pairs for the L4/L5 segmental level was slight (kappa = 0.09). At the L5/S1 level, the interexaminer reliability was fair (kappa = 0.25). For the sacroiliac joints, interexaminer reliability was slight (kappa = 0.04 and 0.14). CONCLUSION: This study of commonly used chiropractic diagnostic methods in patients with chronic mechanical low-back pain to detect manipulable lesions in the lower thoracic spine, lumbar spine, and the sacroiliac joints has revealed that the measures are not reproducible. The implementation of these examination techniques alone should not be seen by practitioners to provide reliable information concerning where to direct a manipulative procedure in patients with chronic mechanical low-back pain.

Adult↗
PubMedDate not supplied

[Yersinia arthritis. Long-term follow up].

Twenty-two patients were followed for a mean of 10.7 years after acute Yersinia arthritis. Their clinical course, agglutinating antibodies, and laboratory parameters of inflammation were analyzed. In 73% of cases HLA-B27 was positive. The acute disease lasted from 1 month to 1 year. One male patient showed a bilateral synostosis of sacroiliac joints at the acute phase of the disease. He developed the clinical characteristics of severe ankylosing spondylitis. Another two patients with HLA-B27 had radiologically inflammatory changes of sacroiliac joints or symphysis without clinical findings. Agglutinating antibodies against dead Yersinia bacilli were negative in all patients. No laboratory signs of inflammation were present. The long-term prognosis of Yersinia arthritis is benign.

Adolescent↗
PubMed1981

Surgical technique of hemipelvectomy in the lateral position.

Hemipelvectomy is most frequently indicated for sarcoma of the upper thigh, hip, or pelvis. With the patient in the lateral position the incision is made through the anterior abdominal wall, and the iliac vessels are dissected free and divided just distal to the aortic bifurcation. The multiple visceral branches of the internal iliac vessels are divided and ligated to expose the sacral nerve roots deep within the pelvis. The posterior skin flap is dissected free and the gluteus maximus muscle severed from its origin on the sacrum. Back muscles are detached from the wing of the ilium and the psoas muscle with accompanying obturator and femoral nerves is divided. The pelvis begins to open as the symphysis pubis is divided. Next the sacral nerve roots are divided and anterior capsule of the sacroiliac joint. The muscles and ligaments of the pelvic floor are severed including the urogenital diaphragm, levator ani muscle, sacrotuberous ligament, and sacrospinalis ligament. The specimen is released by severing the sacroiliac joint posteriorly. The operative defect is closed by suturing gluteal fascia to inguinal ligament over suction drains.

Amputation, Surgical↗
PubMedDate not supplied

[Results of radium 224 therapy in ankylosing spondylitis (Strümpell-Marie-Bechterew disease)].

After an average of 5 years following therapy with Ra224, the concentration of Tc99m methyl diphosphonate (MDP) in the region of the sacroiliac joints and lumbar spine was measured in 15 patients with ankylosing spondylitis. The findings were supplemented by those of clinical, pathological, and roentgenological examinations. The concentration of MDP was normal in the sacroiliac joints in almost all the patients, but was raised in the lumbar spine in two-thirds. This is to be interpreted as indicating enhanced bone turnover, the difference from that in healthy subjects being highly significant (p less than 1). Increased ossification of the lumbar spine could be demonstrated roentgenologically in two-thirds of the patients. Differential blood count, blood sedimentation rate, and electrophoresis remained unchanged after therapy. However, in 60% of patients the mobility of the spine was the same or even improved; 46% felt better after Ra224 treatment than before it.

Adult↗
PubMed2002

Animal models of ankylosing spondylitis.

The pathology of ankylosing spondylitis (AS) and related spondyloarthropathies (SpA) characteristically involve a sacroiliitis and inflammation of the intervertebral discs (IVD) in the lumbar spine, and an enthesitis at sites of ligamentous insertions into bone. The proteoglycans aggrecan and versican are large molecules that aggregate with hyaluronic via a globular 1 domain. These domains share significant homology at the level of B and T cell epitope recognition. Both proteoglycans are present in the intervertebral disc and hyaline cartilages of the sacroiliac joint, as well as in entheses. Whereas aggrecan is most concentrated in the nucleus of the IVD and in articular cartilages and endplates, versican is generally absent from these tissues except in the sacroiliac joint, but is concentrated in ligaments and the annulus. Immunity to these molecules in BALB/c mice results in an AS-like pathology, including sacroiliitis, enthesitis, and discitis. The pathology of AS is closely associated with the expression of the class I molecule human leukocyte antigen-B27. Rats bearing this transgene develop an AS-like pathology, as well as other various signs of autoimmunity. Ankylosing spondylitis is characterized by an ankylosing pathology whereby bone formation in the annulus leads to intervertebral fusion. Mice bearing the ank/ank defect gene develop a bony ankylosis of the spine like that seen in advanced AS and related SpA. These three animal models provide insight into the pathogenesis of SpA, and opportunities to investigate their pathology in relationship to human disease where investigation of the pathobiology is very difficult, because of restricted access to involved tissues.

Animals↗
PubMed1988

The other arthritides. Roentgenologic features of osteoarthritis, erosive osteoarthritis, ankylosing spondylitis, psoriatic arthritis, Reiter's disease, multicentric reticulohistiocytosis, and progressive systemic sclerosis.

Osteoarthritis may be divided into primary generalized and secondary forms. Primary generalized osteoarthritis is characterized by narrowing of cartilage, marginal osteophytes, and absence of erosions. The most common sites of involvement are the distal interphalangeal joints of the fingers and the first carpometacarpal joint. Secondary osteoarthritis also results in narrowing of cartilage in the absence of erosions, but in regions of mechanical stress. Erosive osteoarthritis affects predominantly the proximal and distal interphalangeal joints, and evolves into bony fusion in 12 to 15 per cent of cases, about the same percentage of interphalangeal bony fusion that occurs in psoriatic arthritis. Ankylosing spondylitis predominates in the axial skeleton where it eventually leads to fusion of the vertebrae and sacroiliac joints. Psoriatic arthritis combines many features of rheumatoid arthritis, in which synovial inflammation predominates, and ankylosing spondylitis, in which ligamentous inflammation predominates. The hands and feet are involved to an equal extent, and in 20 per cent of patients the disorder also involves the sacroiliac joints and spine. Reiter's disease, like psoriatic arthritis, differs from ankylosing spondylitis in its inconstant involvement of the spine and greater involvement of peripheral joints. Reiter's disease differs from psoriatic arthritis in its predominant involvement of the lower limbs, particularly the feet, with relative sparing of the hands and wrists. Multicentric reticulohistiocytosis is a rare disorder in which polyarthritis usually precedes the onset of nodular cutaneous eruptions, a fact that emphasizes the importance of early roentgenologic recognition. The interphalangeal joints are the predominant sites of involvement in the hands, but eventually all of the synovium lined joints become affected, with arthritis mutilans the end result in one third of cases. The erosions are strikingly symmetrical and well circumscribed, and accompanying osteoporosis is disproportionately mild. Progressive systemic sclerosis is characterized by atrophy and dystrophic calcifications in the soft tissues, ultimately leading to joint deformities and resorption of the terminal tufts of the phalanges. Resorption of bone occurs at other sites as well, and marginal erosions may develop in the metacarpophalangeal and interphalangeal joints of the hands.

Arthritis, Reactive↗
PubMed2005

Multifocal metastases of recurrent renal cell carcinoma successfully treated with a combination of low dose interleukin-2, alpha-interferon and radiotherapy.

A 59-year-old man presented with a 2-month history of left flank pain and a possibility of gross hematuria. Left renal cell carcinoma stage II was diagnosed and radical left nephrectomy was performed. Twenty-two months postoperatively, lung metastases were demonstrated and 6 x 10(6) units of alpha-interferon (IFN-alpha) were administered for 9 months, only to keep the sizes of the metastases unchanged. Thirty-four months after the operation, liver metastases and bone metastasis in the left sacroiliac joint were revealed. The combination cytokine therapy was performed with 1.4 x 10(6) U of interleukin-2 (IL-2) and 3 x 10(6) U of IFN-alpha for 16 weeks, and the left sacroiliac joint metastasis was treated with radiation therapy of 4 Gy per day for 7 days. Six months after the 16 weeks of immunotherapy, computed tomography and bone scintigraphy revealed that the metastases of the lung, liver and bone substantially disappeared and this complete response is still kept after 16 months.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

The role of standard roentgenograms in the evaluation of instability of pelvic ring disruption.

Anteroposterior pelvic roentgenograms of 154 patients with pelvic ring disruptions were evaluated to assess their value in the determination of pelvic instability. Three different categories of stability were roentgenographically recognizable: (1) stable, characterized by impacted vertical fracture of the sacrum, nondisplaced fracture of the posterior sacroiliac complex, and/or subtle fractures of the upper sacrum evidenced by asymmetry of the sacral arcuate lines; (2) unstable, characterized by hemipelvic cephalad displacement exceeding 0.5 cm, sacroiliac joint diastasis exceeding 1 cm and/or sacral or iliac diastatic fracture exceeding 0.5 cm; and (3) indeterminate (that is, suspicious but not diagnostic of pelvic instability), characterized by cephalad hemipelvic displacement of less than 0.5 cm, sacroiliac joint diastasis less than 1 cm, and/or diastatic fracture of the sacrum or ilium of less than 0.5 cm. Correlation of the standard roentgenographic, computed tomographic, and clinical orthopedic examinations revealed that pelvic stability was accurately evaluated on the standard pelvic roentgenograms in 88% of cases. Disruptions were stable in 70%, unstable in 18%, and suspect in 12% of patients, for whom adjunct roentgenographic and clinical examinations were required. Determination of pelvic stability in the manner described allows immediate identification of patients with a stable or unstable pelvic injury, as well as identification of those with indeterminate stability requiring further clinical or roentgenologic evaluation. Immediate recognition of pelvic instability on standard pelvic roentgenograms obviates the need for additional diagnostic studies that unnecessarily delay the institution of emergency therapeutic measures designed to control associated hemorrhage.

Adult↗
PubMed1991

Quantitative analysis of radiophosphate uptakes in asymptomatic porous-coated hip endoprostheses.

A quantitative analysis of the uptake of radiophosphate adjacent to the femoral component of a porous-coated cementless prosthesis was undertaken in asymptomatic patients in order to establish normal temporal changes. The group consisted of 55 patients with 62 arthroplasties of 1.6-49-mo duration. Ratios of the stem, stem tip, greater trochanter, lesser trochanter and calcar, and normal femur to the reference sacroiliac joint were obtained, as well as tip-to-stem, and stem-to-normal femur in unilateral arthroplasties. The ratios remained stable at 12 months and beyond, except for the tip and lesser trochanter. Tip-to-stem and tip-to-sacroiliac joint ratios decreased by 24% and 33%, respectively, between 12 and 49 mo. There was also a decrease in the relative uptakes at the lesser trochanter and calcar in the same time interval. Evidence is given that different designs of prostheses may not have the same normal temporal uptakes of radiophosphate.

Adult↗
PubMed2000

Sacral stress fracture in a female collegiate distance runner: a case report.

OBJECTIVE: To present the case of a 19-year-old collegiate distance runner diagnosed with a unilateral sacral stress fracture. BACKGROUND: Low back and sacroiliac joint pain are common in female athletes but are often difficult to differentiate. Although sacral stress fractures in young female athletes are rarely reported, they are a potential cause of low back pain. DIFFERENTIAL DIAGNOSIS: Acute lumbosacral strain, disc disease, gluteus maximus strain, idiopathic low back pain, low back strain, sacroiliac joint sprain, or congenital anomaly. TREATMENT: Six weeks of active rest and nutritional counseling followed by an incremental 8-week running program. The athlete returned to symptom-free competitive running within 4 months. UNIQUENESS: This young athlete presented with a unilateral sacral stress fracture with components of the female athlete triad and a vigorous exercise regime. CONCLUSIONS: Sacral stress fractures are rare in the young female athletic population. Because stress fractures in female runners have various etiologies, a thorough patient history and diagnostic imaging are necessary in the evaluation. Athletes can return to their normal activity once a successful management strategy has addressed all components of the female athlete triad while providing adequate rest. Prevention strategies, such as screening for the components of the female athlete triad, may help to decrease injuries and promote healthier lifestyles among this population.

Journal Article↗
PubMedDate not supplied

[Legal assessment of fractures and ruptures of the pelvis].

Since it is very difficult to arrive at a complete picture of the very varied effects of fractures and ruptures in the pelvic region, the few studies that have so far dealt with the assessment of injuries to the pelvic girdle have been unable to develop any uniform guidelines. An analysis of the clinical, radiological and in particular CT studies that have been published to date shows that there is a well-defined relationship between clinical and radiological symptomatology. This allows cases to be assessed expertly and objectively. Where there are unstable pelvic girdle fractures, follow-up examinations can use the extent of symphyseal diastasis and the dislocation of one or both halves of the pelvis in relation to the sacrum as a yardstick to assess the effects of injury on the posterior pelvic girdle and their consequences - effects which would otherwise be difficult to detect. Only where there are symphyseal diastases of more than 15 mm with degenerative alterations of the sacroiliac joint and permanent dislocation of one half of the pelvis does an impairment of earning capacity of 20% apply. Impairment-of-earning-capacity rates of 30-40% are appropriate in cases with completely unstable pelvic girdle fractures involving dislocation of both halves of the pelvis and posttraumatic arthritis in the sacroiliac joints. All other pelvic girdle or iliac wing fractures qualify for a maximum 10% reduction in earning capacity, even if the symphysis has become rigid.

Disability Evaluation↗
PubMed1983

Clinical symptoms and signs useful in the early diagnosis of ankylosing spondylitis.

Seventy patients between the ages of 18 to 30 with early spondylitis (eAS), with bilateral grade II-III sacroiliitis without syndesmophytes were examined. The control group comprised 32 patients of the same age range with lumbar disc disease (LDD) confirmed by radiculography, without changes in the sacroiliac joints. In both groups the same clinical parameters were evaluated, calculating for each the specificity, sensitivity and Youden index. Statistical analysis was done using Student's t-test and/or the chi-square test. A complex of simple clinical features was isolated suggesting presence of eAS in young subjects with persistent low back pain but without a clear-cut radiological appearance of the sacroiliac joints. The complex included: a history of morning back stiffness, swelling of knee joints, thoracic pain, clinical evidence of limited chest expansion below 5 cm, swelling of joints of lower extremities, positive Mennell's sign, and in laboratory investigations presence of raised ESR and HLA B27-antigen.

Adolescent↗
PubMed1996

Clinical and biomechanical aspects of external fixation of the pelvis.

OBJECTIVE: The aim was to evaluate the mechanical stability of several traditional and modern external fixators in unstable pelvic ring disruption. DESIGN: In a laboratory study external and internal fixation techniques were tested in seven fresh and five embalmed human pelves with a disruption of the pubic symphysis and one sacroiliac joint (type C1.2 injury according to the Tile-AO classification). BACKGROUND: Stability provided by external fixation depends upon many factors, with the residual pelvic stability being the most important. METHODS: Simulating a single-leg stance, the load was applied quasi-statically to the acetabulum of the unstable hemipelvis. Device failure was defined as displacement >10 mm either at the symphysis pubis or the sacroiliac joint. RESULTS: The frame with the highest failure load (fresh versus embalmed specimens) was the Egbers configuration with the AO fixator (analysis of variance; P < 0.05). Failure was noted at 114.9 N versus 129.5 N. Augmentation of the Mono-Tube by additional internal posterior osteosynthesis gave the following results: sacral bars 325.4 N versus 217.8 N, plate fixation 294.3 N versus 215.8 N, lag screws 338.4 N versus 215.8 N. Failure loads of hybrid fixation of the Orthofix were as follows: sacral bars 257.9 N versus 213.9 N, plate fixation 333.5 N versus 245.3 N, lag screws 397.3 N versus 280.6 N. The differences between the two fixators were not statistically significant. CONCLUSIONS: No single external frame provided sufficient stability. The addition of a posterior internal fixation significantly increased failure loads and controlled the weight-bearing pelvic elements.

Journal Article↗
PubMed2005

Scintigraphic findings in osteoarticular brucellosis.

AIMS: To describe the distribution of bone and joint involvement in 197 patients with brucellosis, and to detail a spectrum of findings on bone scintigraphy in 38 patients with brucellar spondylitis. METHODS: One hundred and ninety-seven patients (141 females, 56 males; age range, 5-77 years) with osteoarticular brucellosis were studied. Patients were classified into acute (62%) and chronic (38%) stages of the disease, and into age groups of less than 16 (1%), 16-30 (17%), 31-45 (29%), 46-60 (37%) and over 60 (16%) years. All patients were evaluated with Tc-methylene diphosphonate bone scanning. Quantification of sacroiliac joint uptake was performed to improve the sensitivity for the detection of sacroiliitis. Plain radiography and computed tomography (CT) or magnetic resonance imaging (MRI) were performed, when required, to evaluate the areas of the skeleton that showed abnormal uptake on the bone scan. MRI and single photon emission computed tomography (SPECT) were performed in all patients who had spinal lesions. RESULTS: The sites most commonly affected were the sacroiliac joints (53%) and spine (19%), followed by the shoulders (16%). Osteoarticular involvement was more common in females (72%) than in males (28%), and the acute stage (62%) was observed more than the chronic stage (38%). Bone and joint involvement occurred at any age, but the most common age group was 46-60 years. Eight scintigraphic patterns were identified in spinal involvement. CONCLUSION: Brucellosis may affect the musculoskeletal system at any site. Bone scan is a useful method to detect osteoarticular involvement in cases of relapse and progression. Spine involvement has the widest range of scintigraphic findings. A knowledge of the location and distribution of osteoarticular involvement as revealed on the bone scan of patients with brucellosis may be valuable in patient treatment and management.

Adolescent↗
PubMed1993

Patterns of vertebral ossification and pelvic abnormalities in paralysis: a study of 200 patients.

To clarify the characteristics, extent, and frequency of spinal ossification and abnormalities of the sacroiliac joint, symphysis pubis, and hip in paralysis, routine radiographs of the lumbar spine, pelvis, and abdomen were retrospectively evaluated in 95 quadriplegic, 105 paraplegic, and 100 age-matched control patients, with attention to age and race and to spinal level and duration of paralysis. The spinal radiographs were evaluated for presence of osteophytes, syndesmophytes, paravertebral ossification, and flowing hyperostosis characteristic of diffuse idiopathic skeletal hyperostosis (DISH); the pelvic radiographs were used to measure the widths of the sacroiliac joint, hip, and symphysis pubis articulations and evaluate for presence of enthesopathy. Bone formation around vertebral bodies was often seen in quadriplegic (n = 41 [43%]) and paraplegic (n = 46 [44%]) patients. In quadriplegic patients, four distinct vertebral ossification patterns were evident: osteophytosis, paraspinal ossification resembling that found in psoriasis, syndesmophytosis, and flowing ossification similar to that in DISH. In paraplegic patients, osteophytosis was most frequent. Vertebral ossification in quadriplegic patients was significantly associated with age (P < .01) and increased in frequency and severity with increasing age.

Adult↗
PubMed1993

[Pelvic fractures in the Kiel trauma surgery clinic. A one-year evaluation].

48 injuries to the pelvis were treated from January 1991 through December 1991. We found 45 fractures of the pelvic ring with associated acetabular fractures in 15 cases and three isolated acetabular lesions. 19 injuries were caused by car accidents, 18 fractures resulted from a fall, especially in older patients. Isolated fractures of the pelvis occurred in 18 cases. The average total severity of the injuries was 19.7 points according to the Hannover Polytrauma Score (PTS). Every fracture was classified using the Tile-classification. There were 15 (33%) Tile A lesions, 18 (40%) Tile B fractures and twelve (27%) type C pelvic ring injuries. In 18 cases surgery was the method of treatment. Seven out of 18 injuries to the acetabulum were treated with open reduction and internal fixation. In ten patients the unstable pelvic ring was fixed by means of an external fixator. To do so, a pair of 6 mm diameter pins were placed on both sides in the supraacetabular region of the iliac bone directed towards the sacroiliac joints. We used a triangular form of external fixation. An open reduction and internal fixation (ORIF) was necessary in five cases, one injury required a combination of external and internal procedures. There were 14 cases in which we found sacral fractures as an additional dorsal lesion. Nine of 14 sacral fractures were recognized only by CT examination. In eleven cases the conventional radiographs showed simple anterior pelvic ring fractures while the CT examination revealed an additional lesion of the sacroiliac joint in nine of these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1988

Two-hole plate fixation for traumatic symphysis pubis diastasis.

Techniques for managing traumatic diastasis of the pubic symphysis include bed rest, hip spica casting, pelvic slings, external fixation, and internal fixation. We report herein our experience with 14 consecutively managed patients in whom we successfully stabilized traumatic pubic diastasis with a single two-hole plate fixation. The average age of the 13 men and one woman was 30 years; followup averaged 17 months. Most of the patients had associated injuries (Injury Severity Score average, 19). Nine patients had concomitant disruption of the sacroiliac joint requiring either delayed open reduction and internal fixation or prolonged skeletal traction; among the five remaining patients, time to mobilization (bed to chair) averaged 1 day. There were no complications attributable to the procedure; i.e., no infections, and no failures of fixation. In this small series of patients early two-hole plate fixation of the traumatic diastasis of the pubis satisfactorily restored the disrupted anterior pelvic ring, contributed to early mobilization of the patients, and made reduction of a concomitantly disrupted sacroiliac joint easier, whether accomplished by skeletal traction or open reduction and internal fixation during a second procedure.

Adolescent↗
PubMed1999

Anti-lactoferrin antibodies and other types of anti-neutrophil cytoplasmic antibodies (ANCA) in reactive arthritis and ankylosing spondylitis.

Fifty-five serum samples from patients with reactive arthritis (ReA), 40 from patients with ankylosing spondylitis (AS) and three from patients with chronic sacroiliac joint arthritis were analysed for the presence of ANCA of IgG class by means of enzyme immunosorbent assay using lactoferrin (Lf), myeloperoxidase (MPO) and antigen extracted from azurophil granules ('alpha-antigen') containing proteinase 3 (PR3) as substrate. IgG-ANCA were found in 31 (56%) patients with ReA. Twenty-three (42%) had anti-Lf antibodies, nine (16%) had anti-MPO and eight (15%) had anti-alpha-antigen antibodies, none of which reacted with PR3. Only six (14%) AS or sacroiliac joint arthritis patients had ANCA (P < 0.001). Three (7%) had anti-Lf, two (5%) anti-MPO and two (5%) anti-alpha-antigen antibodies. Yersinia and Salmonella bacteria were separated by SDS-PAGE and blots were incubated with serum from rabbits immunized with human Lf. The hyperimmune serum recognized a band of 78 kD from both bacteria which was not seen when preimmune serum was used. The reaction to the 78-kD antigen could be completely inhibited when anti-Lf antibodies were absorbed on Lf coupled to cyanogen bromide-activated Sepharose, possibly indicating cross-reacting epitopes in Lf and enterobacterial antigen.

Adult↗