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At least 1,207 records · Page 67Linked to original sources
PubMed2001

Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain.

BACKGROUND: Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants in discriminating between patients who are asymptomatic and those who have low back pain. However, little objective evidence is available concerning variations in PA stiffness and their clinical significance. Moreover, although several studies have assessed only load input in relation to stiffness, a more complete assessment based on dynamic stiffness measurements (force/velocity) and concomitant neuromuscular response may offer more information concerning mechanical properties of the low back. OBJECTIVE: To determine the stiffness and neuromuscular characteristics of the symptomatic low back. STUDY DESIGN: This study is a prospective clinical study investigating the in vivo mechanical and muscular behavior of human lumbar spinal segments to high loading rate PA manipulative thrusts in research subjects with low back pain (LBP). METHODS: Twelve men and 10 women, aged 15 to 73 years (mean age of 42.8 +/- 17.5 years) underwent physical examination and completed outcome assessment instruments, including Visual Analog Scale, Oswestry Low Back Disability Index, and SF-36 health status questionnaires. Clinical categorization was made on the basis of symptom frequency and LBP history. A hand-held spinal manipulation device, equipped with a preload control frame and impedance head, was used to deliver high-rate (<0.1 millisecond) PA manipulative thrusts (190 N) to several common spinal landmarks, including the ilium, sacral base, and L5, L4, L2, T12, and T8 spinous and transverse processes. Surface, linear-enveloped, electromyographic (sEMG) recordings were obtained from electrodes (8 leads) located over the L3 and L5 paraspinal musculature to monitor the bilateral neuromuscular activity of the erector spinae group during the PA thrusts. Maximal-effort isometric trunk extensions were performed by the research subjects before and immediately after the testing protocol to normalize sEMG data. The accelerance or stiffness index (peak acceleration/peak force, kg-1) and composite sEMG neuromuscular reflex response were calculated for each of the thrusts. RESULTS: Posteroanterior stiffness obtained at the sacroiliac joints, transverse processes, or spinous processes was not different for subjects grouped according to LBP chronicity. However, in those with frequent or constant LBP symptoms, there was a significantly increased spinous process (SP) stiffness index (7.0 kg-1) (P <.05) in comparison with SP stiffness index (6.5 kg-1) of subjects with only occasional or no LBP symptoms. Subjects with frequent or constant LBP symptoms also reported significantly greater scores on the visual analog scale (P =.001), Oswestry (P =.001), and perceived health status (P =.03) assessments. The average SP stiffness index was 6.6% greater (P <.05) and 19.1% greater (P <.001) than the average sacroiliac stiffness index and average transverse process stiffness index, respectively. CONCLUSIONS: This study is the first to assess erector spinae neuromuscular reflex responses simultaneously during spinal stiffness examination. This study demonstrated increased spinal stiffness index and positive neuromuscular reflex responses in subjects with frequent or constant LBP as compared with those reporting intermittent or no LBP.

Adolescent↗
PubMed2006

The advanced imaging of gouty tophi.

Gout is a metabolic disorder in which there is hyperuricemia caused by an increase in production or a decrease in excretion of uric acid. Long-lasting hyperuricemia causes the deposition of monosodium urate crystals in the joints and soft tissues, triggering gouty arthritis and, if not properly treated, the formation of gouty tophi. The diagnosis of gout is usually based on clinical presentation and laboratory examinations, long before any abnormality can be demonstrated with imaging. Radiography is the primary imaging modality used in the initial evaluation of gouty arthritis. Ultrasonography, CT, MRI, and nuclear medicine are seldom necessary. Occasionally a tophus has an unusual presentation and simulates neoplasm or infection prompting the utilization of cross-sectional imaging for further evaluation and surgical planning. Cross-sectional imaging is also used in areas that are difficult to visualize on radiographs such as spine, sacroiliac joints, and soft tissues.

Diagnosis, Differential↗
PubMed1991

Anterior and posterior internal fixation of vertical shear fractures of the pelvis.

A laboratory study was undertaken to evaluate the effectiveness of alternative methods of fixation of unilateral vertical shear fractures of the pelvis. Prior to experimental testing, a biomechanical analysis was performed to estimate the forces that displace the hemipelvis in the presence of two different patterns of injury: an interforaminal sacral fracture and a disruption of the sacroiliac joint. These lesions were then experimentally created in five unembalmed human pelvises and sequentially fixed with an external Hoffmann frame alone, a Hoffmann frame with sacral bars, or sacral bars with either one or two bone plates placed across the symphysis pubis. Each pelvis/fixator system was mechanically tested by loading along the direction of the resultant muscle force predicted by the biomechanical analysis. During loading the proximal migration of the ilium was continuously recorded with a transducer. At intervals during loading, the three-dimensional displacement of the detached hemipelvis at the pubic symphysis was also measured using a stereophotographic technique. With both the sacral fracture and the sacroiliac disruption, the addition of posterior sacral rods substantially increased the strength and rigidity of fixation provided by the Hoffmann fixation frame alone (p less than 0.01). In specimens with a sacral fracture, the use of anterior plates with posterior rods restored 65-71% of the strength of the intact pelvis, in comparison with 46% observed with the combination of sacral rods with an anterior Hoffmann frame (p less than 0.01). All of the methods of fixation evaluated in this study were less successful in stabilizing the sacroiliac disruption.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1987

[Articular manifestations in patients with Reiter's syndrome].

The polyetiology, the discrepancies in the initial manifestations, polymorphism in the course and the possibility of the ephemerality or absence of ocular, uro-genital and skin-mucosal manifestations create jointly the preconditions for a frequent diagnostic error in Reiter syndrome. The study confirmed the thesis that the diagnostic characteristics including the articular symptomatics are among the most striking ones. Synovial-arthritis and the involvement of the soft tissues are accompanied by disorders in the immune system with increased number of early T-lymphocytes, of Fc Gd and complement (C3b)-receptor lymphocytes and of spontaneously blast-transformed cells. The rheumatological process is characterized by proportionately accumulation of 99m Tc-pertechnetate and 99m Tc-pyrophosphate in the affected articular structures, with asymmetry of affection, with predilection and maximal capture of the radiopharmaceutical in the feet. The radioisotope information is on scanty alterations in the spine and sacroiliac joints. The complex study facilitates the timely diagnosis of the disease.

Adolescent↗
PubMed1989

The enthesopathic changes of hypophosphatemic osteomalacia in adults: radiologic findings.

The enthesopathy (bone proliferation at sites of ligament, tendon, joint capsule, and interosseous membrane attachment) that may be present in adults who have longstanding hypophosphatemic osteomalacia, the most common type of osteomalacia, has received little attention in the radiologic literature. These proliferative enthetic changes may be associated with various musculoskeletal symptoms. The spectrum of proliferative enthesopathic changes, involving the axial and appendicular skeleton, is described in six patients 18-63 years old. Proliferative changes at the attachment of the annulus fibrosus were present in six of six patients and ranged in extent from tiny hyperostoses at a few levels to thin marginal symmetric syndesmophytes involving the entire lumbosacral spine and mimicking spondylitis. Thoracic spinal syndesmophytes were present in four patients and cervical hyperostoses of various magnitudes were present in three patients. Changes in the sacroiliac joints were present in four of six patients and varied from mild widening to symmetric intraarticular and anterior paraarticular bony bridging. Proliferative enthesopathy involving the pelvis and proximal femora was present in six of six patients. Appendicular changes included accessory ossicles within the wrist and hands and bony proliferation of the distal radius and metacarpal heads. These were noted in four patients. Ossification of the interosseous membrane of the forearms or the lower extremities was present in six patients and paraarticular bony proliferation about the elbows was noted in four patients. It is apparent that the severity of the enthesopathy that occurs may vary, and that hypophosphatemic osteomalacia should be recognized as a cause of enthesopathy even if other radiographic findings of osteomalacia may not be present on available radiographs.

Adolescent↗
PubMed1997

Identification of childhood arthritis in archaeological material: juvenile rheumatoid arthritis versus juvenile spondyloarthropathy.

The opportunity to examine the defleshed skeleton of an individual diagnosed in life (Hamann-Todd collection, individual 2036) afforded a unique opportunity to demonstrate the bone damage characteristic of at least one form of juvenile rheumatoid arthritis (JRA). Characteristics helpful for recognition of JRA in archaeological material include peripheral articular marginal and subchondral erosions, axial (e.g., zygapophyseal or sacroiliac) joint erosions, fusion of axial (cervical zygapophyseal) and/or peripheral joints, premature epiphyseal closure and/or ballooned epiphyses, growth retardation with underdeveloped (short and overtubulated) long bones, short mandibular rami with underdeveloped condyles and concomitant micrognathia, and demineralization (osteopenia). Distinguishing between JRA and juvenile spondyloarthropathy, however, is not always possible, as illustrated by this case.

Anthropology, Physical↗
PubMed2000

Lumbosacral plexopathy in pelvic trauma.

We reviewed the electrophysiologic data and the etiology of lumbosacral plexopathy in 22 consecutive patients with pelvic trauma referred for electromyography (EMG). Most (68%) patients had sacral fractures or sacroiliac joint separation, 14% had acetabular fractures, and 9% had femoral fractures. Lumbosacral plexopathy was significantly more common (P = 0.0026) among patients with sacral fractures (incidence of 2.03%) than among the entire population of patients with pelvic and acetabular fractures (overall incidence 0. 7%). Patients with acetabular and femoral fractures may have suffered injury to multiple proximal nerves originating from the plexus rather than injury to the plexus, as confirmed by magnetic resonance imaging (MRI) neurogram in select cases.

Action Potentials↗
PubMed2000

Successful treatment of active ankylosing spondylitis with the anti-tumor necrosis factor alpha monoclonal antibody infliximab.

OBJECTIVE: Tumor necrosis factor alpha (TNFalpha) has been detected in sacroiliac joint biopsy specimens from patients with spondylarthropathy. The present open pilot study was undertaken to test the efficacy of the anti-TNFalpha monoclonal antibody infliximab in the treatment of active ankylosing spondylitis (AS). METHODS: Eleven patients with AS of short duration (median 5 years, range 0.5-13 years) that had been active for at least 3 months (range 3-72 months) were treated with 3 infusions of infliximab (at weeks 0, 2, and 6), in a dosage of 5 mg/kg. Ten of the 11 patients had elevated C-reactive protein (CRP) levels (>6 mg/liter) before treatment; these elevations were known to have had persisted > 1 year in at least 3 patients. The Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), pain as measured on a visual analog scale, and the Bath AS Metrology Index (BASMI) were assessed. Quality of life was assessed using the Short Form 36 instrument. Laboratory markers of disease activity, including interleukin-6 (IL-6) levels, were determined. Dynamic magnetic resonance imaging (MRI) of the spine was performed in 5 patients. RESULTS: One patient withdrew from the study due to the occurrence of urticarial xanthoma 8 days after the first infusion. At study enrollment, 3 of 5 patients had evidence of spinal inflammation (spondylitis and spondylodiscitis) as detected by MRI; followup MRI 2-6 weeks after the third infusion revealed improvement in 2. Improvement of > or = 50% in activity, function, and pain scores was documented in 9 of 10 patients; the median improvement in the BASDAI after 4 weeks was 70% (range 41-94%). This clear-cut benefit lasted for 6 weeks after the third infusion in 8 of 10 patients. The median CRP level decreased from 15.5 mg/liter (range <6-90.8) to normal, and the median IL-6 level from 12.4 mg/liter (range 0-28.4) to normal (<5). There was improvement in all 9 SF-36 concepts; the improvement was significant for 6 concepts. CONCLUSION: These data suggest that anti-TNFalpha therapy is very effective for several weeks in AS. Whether this therapy, in addition to its antiinflammatory effect, prevents ankylosis remains to be determined.

Adult↗
PubMed1991

Ontogeny and evolution of pelvic diameters in anthropoid primates and in Australopithecus afarensis (AL 288-1).

Pelvic diameters (both anteroposterior [AP] and transverse [TR]) were investigated in a series of anthropoid primates. The ratio of diameters (AP/TR) in each of three pelvic planes (inlet, midpelvis, and outlet) was calculated. In addition to the above, the length of the iliac, pubic, and ischial axes and the angles between these axes were determined. The AP/TR ratio at the pelvic inlet is (reported in millimeters, +/- SD, unless otherwise specified) 1.81 +/- 0.27 in New World monkeys (Cebidae) and Macaca mulatta; 1.53 +/- 0.17 in hylobatids and pongids; 0.87 +/- 0.08 in Homo sapiens; and 0.58 in Australopithecus afarensis (AL 288-1). The AP/TR ratio in the midpelvis is 1.61 +/- 0.23 in nonhominid primates (Cebidae, M. mulatta, hylobatids, and pongids), 1.12 +/- 0.11 in humans, and 0.59 in AL 288-1. In monkeys (Cebidae and M. mulatta), hylobatids, pongids, H. sapiens, and AL 288-1, the ratios of the length of the pubic axis over the ischial axis were 0.84 +/- 0.06, 0.95 +/- 0.07, 1.10 +/- 0.15, and 1.46, respectively; the pubis-ilium angles were 96 +/- 11, 120 +/- 10, 131 +/- 11, and 147 degrees, respectively; and the ischium-pubis angles were 106 +/- 11, 86 +/- 8, 96 +/- 7, and 68 degrees, respectively. In none of these pelvic features was AL 288-1 "intermediate" between pongids and H. sapiens. The anatomical peculiarities of the pelvis in AL 288-1 are explained primarily as the result of early adaptation to erect posture, which resulted in the reduction of the distance between the sacroiliac joint and the hip joint. As a consequence, the sacral promontory moved toward the pubic symphysis, and this resulted in shortening of the AP diameter and widening of the TR diameter at the pelvic inlet.

Animals↗
PubMed1994

Multivariate analysis of the sexual dimorphism of the hip bone in a modern human population and in early hominids.

A large sample of hip bones of known sex coming from one modern population is studied morphologically and by multivariate analysis to investigate sexual dimorphism patterns. A principal component analysis of raw data shows that a large amount of the hip bone sexual dimorphism is accounted for by size differences, but that sex-linked shape variation is also very conspicuous and cannot be considered an allometric consequence of differences in body size between the sexes. The PCA of transformed ("shape") variables indicates that the female hip bones are different in those traits associated with a relatively larger pelvic inlet (longer pubic bones, a greater degree of curvature of the iliopectineal line, and more posterior position of the auricular surface), as well as a broader sciatic notch. The analysis of nonmetric traits also shows marked sexual dimorphism in the position of the sacroiliac joint in the iliac bone, in the shape of the sciatic notch, in pubic morphology, and in the presence of the pre-auricular sulcus in females. When the australopithecine AL 288-1 and Sts 14 hip bones are included in the multivariate analysis, they appear as "ultra-females." In particular these early hominids exhibit extraordinarily long pubic bones and iliopectineal lines, which cannot be explained by allometry.

Analysis of Variance↗
PubMed1990

Scintigraphic evaluation of lumbosacral pain in brucellosis.

Low back pain is the most frequent rheumatologic manifestation of brucellosis. The diagnosis of brucellar sacroiliitis is hampered by the poor specificity of the clinical data and the poor sensitivity of the radiologic data. In this report, we show that scintigraphy not only increases the sensitivity but also allows an earlier diagnosis of disease and permits the detection of osteoarticular brucellar involvement in areas adjacent to the sacroiliac joint.

Back Pain↗
PubMed2001

Computer-assisted percutaneous transiliac approach to tumorous malformation of the sacrum.

The object of this article is to present a new, minimally invasive, percutaneous image-guided technique for surgery of tumorous malformation of the sacrum. Using one of the available CAS systems, we developed a navigable working tube through which various surgical tools may be very precisely introduced into the tumorous malformation. The tube allows us to obtain histological samples and also perform tumor resections. For sacral procedures, the working tube was introduced percutaneously into the affected area of the sacrum through the sacroiliac joint with computer assistance. For successful matching, small titanium screws were inserted into the sacrum and pelvis percutaneously before CT examination to give precise landmark points. We have used the method in 12 cases. The aim of the surgery in biopsy cases was to obtain samples for histological diagnoses of unknown tumors. In the cases of tumor resection (all were metastatic), the indication was to obtain neurological decompression and decreased local pain. The pain response was very effective in all cases. The transiliac percutaneous approach to the sacrum has proven to be a safe and well-designed procedure. It can even be performed under local anesthesia, and is thus a very effective minimally invasive tool for obtaining pain relief in cases of sacral metastasis involving the first, second, and third segments.

Humans↗
PubMed2001

Patterns of failure in squamous cell carcinoma of the vagina treated with definitive radiotherapy alone: what is the appropriate treatment volume?

The purpose of this study was to review treatment results, sites of failure, and complications in relation to the irradiation volume for carcinoma of the vagina treated with radiotherapy alone. A retrospective review of 65 patients with histologically confirmed squamous cell carcinoma of the vagina who received definitive radiotherapy was undertaken. The 5-year cause-specific survival rates were as follows: Stage I, 91%; Stage IIA (paravaginal extension), 90%; Stage IIB, 55%; Stage III, 89%; and Stage IVA, 62%. The pelvic disease control rates at 5 years were as follows: Stage I, 74%; Stage IIA, 90%; Stage IIB, 79%; Stage III, 89%; and Stage IVA, 67%. Recurrence in the pelvis occurred in 22% of patients. Eighty-five percent of pelvis recurrences were in the primary treatment field. Although pelvic control rates were not increased by use of larger treatment fields (>2,700 cm(3)), moderate acute and late effects were increased with these fields. Carcinoma of the vagina appears to have a different failure pattern than carcinoma of the cervix. The primary failure sites are the vagina and the paracolpal tissues and the inguinal nodes. Because of this, the superior edge of the pelvic fields does not have to extend above the bottom of the sacroiliac joints except with advanced lesions.

Carcinoma, Squamous Cell↗
PubMed1998

Cloning and sequencing of the gene that codes for the Klebsiella pneumoniae GroEL-like protein associated with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the sacroiliac joints and vertebral column of unknown aetiology, but strongly related to the presence of the HLA-B27 antigen. The participation of bacterial infections as triggering factors have also been suggested. We have associated the 60 kDa heat shock protein of Klebsiella pneumoniae (HSP60Kp) with AS since we have previously demonstrated that most of the patients have IgG antibodies and active T cells that recognize preferentially this protein, but we have not yet identified the epitopes involved in the recognition. In order to know the amino acid sequence of HSP60Kp, and to be able to analyse in the future the relevant epitopes; we amplified by PCR and cloned the gene coding for this protein into the SmaI site of pUC19. The nucleotide sequence of the gene was obtained by the Sanger method using both manual and automatic techniques. Amino acid sequence of the HSP60Kp was deduced by translating the nucleotide sequence of the gene. The antigenic analysis of this sequence was compared to the antigenic analysis of the reported sequences of Escherichia coli GroEL and Yersinia enterocolitica HSP60. Using a software to predict HLA class I motifs, the nonapeptide (KRGIDKAVL) residues 117-125 of HSP60Kp showed a much higher affinity for HLA-B27 than the similar nonapeptide of E. coli GroEL and Y. enterocolitica HSP60. The only difference between the three peptides was in position nine. This finding could explain the association of AS only with the HSP60 of Klebsiella pneumoniae. On the other hand, hydrophilicity analysis, which indicates B cell epitopes, showed three similar strongly antigenic regions in the three proteins.

Amino Acid Sequence↗
PubMed1995

Association of intermediate uveitis with HLA-A28: definition of a new systemic syndrome?

BACKGROUND: Endogenous posterior uveitis (PU) can be associated with systemic diseases, and certain forms have strong association with HLA antigens. Much less is known regarding intermediate uveitis (IU). The purpose of this study was to determine whether IU is associated with the HLA system and whether it can be associated with systemic symptoms. METHODS: In 179 consecutive patients consulting for uveitis, a detailed history was obtained and a physical examination performed. HLA typing for 71 HLA-A, B, DR and DQ antigens, laboratory tests, and radiography of the chest, sinuses, and sacroiliac joints were systematically performed. RESULTS: Thirty-two patients (18%) had IU; 51 (28.5%) had PU and constituted our internal control group. Nine of the patients with IU (28%) had the HLA-A28 antigen, compared with 8.1% of a healthy control population and 8.6% of the patients with PU (P < 0.001). An associated disease was found in four patients with IU (12.5%) (none was HLA-A28) and in 45% of the patients with PU (P < 0.01). Some 67% of HLA-A28 patients with IU had arthralgias affecting the knee(s), compared with 17% of non-HLA-A28 patients and 18% of patients with PU (P < 0.05 and P < 0.01 respectively); 55% had gonalgias and hypocomplementemia compared with 9% and 2% respectively (P < 0.01 and P < 0.001). CONCLUSIONS: IU is significantly associated with HLA-A28; patients having this antigen may represent a subset of the disease characterized by an increased prevalence of arthralgias and hypocomplementemia.

Adolescent↗
PubMed1990

Ewing's sarcoma of the pelvis.

Two hundred and thirty-nine patients with Ewing's sarcoma were treated at our institution between 1972 and 1987: 42 of these had lesions in the pelvis, 29 were in the wing of the ilium or involved the sacroiliac joint (type I), 5 were periacetabular (type II), and 8 were in the anterior pelvic arch (type III). Radiotherapy alone was used for the primary lesion in 11 cases, adjuvant chemotherapy in 20 and a neoadjuvant protocol in 22. The overall disease-free survival at a mean follow up of 34 months was 19%. There was no difference in survival related to age or the site in the pelvis, none in disease-free survival with adjuvant and neoadjuvant chemotherapy, or in the incidence of local recurrence and metastases in these two groups. Similarly, there was no difference in disease-free survival between operative treatment, with or without radiotherapy, and radiotherapy alone. There was a slight trend towards better local control of the disease in the former group compared to the latter, although this difference was not statistically significant. Our conclusion is that treatment needs to be planned for each individual patient.

Adolescent↗
PubMed1990

Nutrient groove of the ilium, a subtle but important forensic radiographic marker in the identification of victims of severe trauma.

A variety of skeletal characteristics pertaining to the bony pelvis have, over the years, been of assistance as forensic markers, but the importance of the nutrient groove of the ilium has not been appreciated. During aircraft accident investigations we compared premortem anteroposterior abdominal radiographs with postmortem specimen radiographs of the ilium, with particular attention directed to the nutrient groove of the ilium. This marker can assume several configurations (i.e., parallel, V-shaped and Y-shaped) and is situated a few centimeters lateral to the sacroiliac joint. Left/right asymmetry, or absence of the nutrient grove on one side of the pelvis are possible variants within an individual. The purpose of this report is to emphasize the previously unrecognized importance of the nutrient groove of the ilium as a useful forensic radiographic marker.

Accidents, Aviation↗
PubMed1995

MRI of occult sacral insufficiency fractures following radiotherapy.

Following radiation therapy, marrow abnormalities noted on magnetic resonance imaging (MRI) are frequent and may mimic metastases. Specific radiotherapy changes are usually easily identifiable; however, traumatic lesions cause more interpretive difficulties. We assessed the incidence and MRI characteristics of insufficiency fractures in this population. During a 5-year span (1987-1991), 546 patients received pelvic radiotherapy for primary malignancies. MRI was performed in 25 of these patients at least 3 months after treatment. The mean dose in this group was 53 Gy. These MRI scans were retrospectively reviewed for the appearance of the sacrum with particular attention to the presence of insufficiency fractures. This was correlated with clinical course and scintigraphic findings. Presumed insufficiency fractures on MRI paralleled the sacral side of the sacroiliac joint, enhanced with Gd-DTPA, were most prominent or initially seen anteriorly, and had ill-defined margins on all imaging sequences. The incidence of occult sacral insufficiency fractures was at least 20%. Insufficiency fractures of the sacrum in the post-radiotherapy patient are a relatively frequent occurrence which can mimic metastases. Consideration of this phenomenon and knowledge of differential features may avoid overdiagnosis of osseous metastases.

Diagnosis, Differential↗