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At least 1,387 records · Page 77Linked to original sources
PubMed1983

Detection of osteoporotic sacral fractures with radionuclides.

Osteoporotic sacral fractures usually occur in elderly patients as a result of mild trauma. Clinical symptoms range from localized sacral tenderness to neurologic problems attributable to sacral nerve root irritation or cauda equina compression. Although the radiographic diagnosis is difficult to establish, bone scans show a characteristic H-shaped pattern of radionuclide uptake across the sacrum and sacroiliac joints. Four cases of osteoporotic sacral fracture with confirmation by computed tomography are included in this report.

Aged↗
PubMed1984

Intraosseous pneumatocysts of the ilium. Findings on radiographs and CT scans.

CT scans demonstrated a localized collection of gas adjacent to a normal sacroiliac joint in 5 patients. In each case the lesion was sharply demarcated by a thin sclerotic rim. A benign bone cyst was confirmed histologically in 2 cases. The radiologist should be aware of this appearance so as to avoid invasive procedures based on a misdiagnosis of infection or neoplasm.

Adult↗
PubMed1986

Sternocostoclavicular hyperostosis: a review and report of 11 cases.

Sternocostoclavicular hyperostosis is a benign ossifying diathesis of unknown etiology characterized by hyperostosis and soft-tissue ossification between the clavicles, anterior portion of the upper ribs, and manubrium, with variable hyperostosis or ankylosis in the spine and sacroiliac joints. Our cumulative experience with 11 cases is reported, with emphasis on radiographic features of the condition. Scintigraphic results in five patients and computed tomographic findings in one patient are presented. A review of the literature and our own material indicates that sternocostoclavicular hyperostosis may be more common than has been previously recognized.

Adult↗
PubMed1986

CT of sacral injury.

Eighty-eight patients with 188 sacral fractures were examined with computed tomography (CT) and conventional radiography. Four main patterns of sacral injury were defined: sacroiliac diastasis (39%), sacral and/or iliac lip fractures (25%), vertical shear fractures (25%), and comminuted fractures (5%). Initial interpretation of plain radiographs failed to define 29% of the sacroiliac joint diastases, 57% of the lip fractures, 34% of the vertical shear fractures, and 25% of the comminuted fractures. The extent of injury was better delineated with CT, and a more certain diagnosis of sacral injury was possible with CT than with radiography. Because of the higher detection rate and improved imaging of fracture configuration, CT should be performed in all patients with sacral injury.

Adolescent↗
PubMed1989

X-linked hypophosphatemia in adults: prevalence of skeletal radiographic and scintigraphic features.

The radiologic studies of 38 essentially untreated adults with X-linked hypophosphatemia (XLH) were reviewed to determine the prevalence of radiologic features, to compare the findings in men and in women, and to elucidate the natural history of the disease by comparing the findings in young, intermediate-age, and older patients. Bone-reinforcement lines were common, but no characteristic mineral mass alteration was established. Looser zones were more prevalent in older subjects. Osteoarthritis was common, occurring in the ankles, knees, feet, sacroiliac joints, and wrists. Enthesopathy was infrequent in the younger group but was present in every member of the intermediate and older groups and was often accompanied by extra ossicles. Curvatures of the lower-extremity long bones were common in all age groups. Three new skeletal alterations in XLH were found to be common: flaring of the iliac wings, trapezoidal distal femoral condyles, and alterations in talar morphology, including shortening of the talar neck and flattening of the talar dome. Technetium-99m methylene diphosphonate scintigrams of 17 subjects were often abnormal, depicting bowing deformity and focal tracer accumulation in diaphyseal cortices and in periarticular and extraarticular regions. The mean metabolic index was moderately elevated (4.0). Both radiographic and scintigraphic findings were more severe in men, consistent with hemizygosity. The natural history of untreated XLH in both sexes is characterized by the development of a variety of age-related skeletal abnormalities during adulthood.

Adult↗
PubMedDate not supplied

Spinal changes in patients with spondyloarthritis: comparison of MR imaging and radiographic appearances.

Since the advent of highly effective TNF-alpha inhibitors for treating spondyloarthritides, referring rheumatologists have been requesting the sensitive visualization of inflammatory changes not only of the sacroiliac joints but of the entire spine. Given that changes in spondyloarthritis may be very subtle, their visualization by means of magnetic resonance (MR) imaging relies critically on selecting the proper imaging protocol. Spinal changes associated with spondyloarthritis are florid anterior spondylitis (or Romanus lesion), florid diskitis (or Andersson lesion), ankylosis, insufficiency fractures of the ankylosed spine, syndesmophytes, arthritis of the apophyseal and costovertebral joints, and enthesitis of the interspinal ligaments. A comparison of MR imaging findings with those of conventional radiography in individual patients reveals strengths and weaknesses of both modalities. Results of this comparison suggest that syndesmophytes are depicted better with radiography; ankylosis, equally well with both imaging techniques; and all other lesions, better with MR imaging. Classification of the different findings based on the typical signal-intensity changes seen on MR images enables standardized reporting, and scoring the lesions may be helpful in clinical trials.

Humans↗
PubMed2007

Is fluoroscopy essential for retrieval of lower ureteric stones?

INTRODUCTION: The aim of this study was to assess the efficacy of ureteroscopy for lower ureteric stones without the use of fluoroscopy. PATIENTS AND METHODS: Between June 2001 and January 2005, a total of 110 patients with a mean age of 33.5 years (range 12-65) suffering from of lower ureteral calculi (below the upper margin of the sacroiliac joint) prospectively underwent ureteroscopic removal. Retrograde pyelography was avoided, and no safety guidewire was placed. Whenever required, the ureteric meatus was dilated with a ureteric balloon under direct vision. Double-J stent placement was done with the aid of ureteroscopy. A fluoroscope was kept standby. The patients had a postoperative X-ray of the kidney-ureter-bladder region to document the stone clearance. RESULTS: The mean stone size was 8.7 mm (range 6-15). Complete clearance without the use of fluoroscopy was achieved in 99 patients (94.2%). Fluoroscopy was required in 6 patients (4%) for calcified stricture (n = 1), duplex system (n = 1), narrow and tortuous meatus causing difficulty in passing the 5-Fr balloon dilator (n = 3), and confirmation of spontaneous passage of the stone (n = 1). Of the 13 patients who required balloon dilatation it was successfully achieved without fluoroscopy. Double-J stenting was done due to mucosal ulceration (n = 3), polypoid reaction (n = 2), and perforation (n = 1). All these patients had correct placement of the stent, as confirmed by X-ray of the kidney-ureter-bladder region postoperatively. CONCLUSIONS: To uphold the notion for radiation exposure to be as low as reasonably achievable, ureteroscopic stone retrieval can safely be done without the use of fluoroscopy in a significant number of patients.

Adolescent↗
PubMed1995

Transcutaneous electrorectography: human electrorectogram from surface electrodes.

The rectal electric activity or electrorectography was recorded transcutaneously in 24 healthy volunteers (mean age 39.6 years). A silver-silver chloride electrode was applied lateral to each of the two sacroiliac joints, and a third one was placed midway between the left greater trochanter and the ischial tuberosity. The reference electrode was applied to the right lower limb. At least two 20-min recording sessions were performed for each of the 24 subjects. In addition, an intrarectal electrorectographic recording was done in 10 of the 24 subjects using silver-silver chloride electrodes attached to the rectal mucosa by suction. Pacesetter potentials (PPs) were recorded transcutaneously. The wave was triphasic with a small positive, a large negative and another small positive deflection. PPs had a regular rhythm and were reproducible. The mean frequency was 3.1 cycles/min. The transcutaneously recorded PPs could be confirmed by the intrarectal route. Both routes had similar electrorectographic recordings, except for the action potentials (APs) which did not show in the transcutaneous electrorectogram. In conclusion, the study demonstrates that PPs could be recorded transcutaneously. Transcutaneous electrorectography is simple, easy, reproducible and cost-effective, and may prove to be a useful investigative tool in the diagnosis of anorectal disorders.

Action Potentials↗
PubMed1988

Extracorporeal shock wave lithotripsy of proximal and distal ureteral stones.

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of 105 patients with ureteral stones. There were 77 stones in the upper part of the ureter, i.e. above the pelvic brim, and 28 in the lower part, i.e. below the sacroiliac joint. Successful fragmentation was attained in 101 (96%). In 93% of the patients with stones in the upper ureter and in 100% with stones in the lower ureter the fragments were eliminated completely. In 87% of the patients with stones in the upper ureter, a ureteral catheter was introduced under local anesthesia but without fluoroscopic control. It was thereby possible to remove 30% of the stones from the ureter to the kidney. For the remaining stones, saline was infused through the catheter during ESWL. For patients with stones in the lower part of the ureter, a ureteral catheter was passed in 79% and saline infused during treatment. Whereas some form of anesthesia was used for treatment of all upper ureteral stones, 89% of the treatments for lower ureteral stones were performed without anesthesia. Auxiliary procedures after ESWL were limited to four ureteral catheter manipulations for distal stones. Four proximal stones which remained unaffected by ESWL had to be treated by open surgery (3 stones) or percutaneous surgery (1 stone). Of 82 ureteric stones treated in situ the success fragmentation rate was 95%. The average number of ESWL sessions was 1.04 for both proximal and distal ureteral stones.

Adolescent↗
PubMed1996

Metastatic multicentric neurofibrosarcoma of the lumbosacral plexus in a cow.

A metastatic multicentric neurofibrosarcoma of the lumbosacral plexus in an adult cow is described. The left lumbosacral plexus was obliterated by a mass which extended through the intervertebral foramen into the spinal canal and between the dorsal arches of the fifth and sixth lumbar vertebrae. A closely associated (possibly contiguous) mass extended into and separated the left sacroiliac joint. Multiple similar masses involved peripheral nerves and skeletal muscles of the pelvis, pelvic limbs, and abdominal wall. Metastatic lesions were scattered throughout the lungs. The lumbosacral lesion and all other masses consisted of interwoven bundles of loosely cohesive, elongated cells separated by variable collagenous matrix. Many neoplastic cells were positive for S-100 protein. Ultrastructurally, fibroblastic cells were mixed with scattered cells possessing schwannian characteristics.

Animals↗
PubMed2005

Severe uncontrolled pain in buttock in a patient on naltrexone: a diagnostic challenge.

A 26-year-old woman with a history of intravenous drug use was admitted to hospital with worsening pain in the right buttock radiating to the lateral part of the thigh and to the calf with no suspicion of cauda equina compression. Eventually, a diagnosis of sacroiliitis was made and appropriate antibiotics were administered. Provision of analgesia for this patient was difficult. On admission her medications included naltrexone, venlafaxine and tramadol. Initially naltrexone was continued and analgesia provided by epidural local anaesthetic and clonidine, intravenous ketamine and oral agents. After several days, naltrexone was ceased and opioids were used in addition to the other analgesics. The epidural analgesia was only partially effective, perhaps because of inadequate blockade of the L4-S1 nerve roots, which carry sensation from the sacroiliac joint. Naltrexone is a long-acting opioid antagonist. If opioid analgesia is planned, it is necessary to cease naltrexone for 24 to 72 hours. In an emergency, if non-opioid techniques prove ineffective, short-acting opioids can be titrated to effect in a monitored environment.

Adult↗
PubMed2005

Disseminated liposarcoma in a dog.

A 9-year-old, female Mongrel dog was presented for posterior hindlimb weakness, inability to stand, and pain in the lumbosacral and pelvic regions. Radiography revealed a lytic lesion extending from L5 to L6 to the ilium. At necropsy, an 8 x 2 to 3.2 x 3 cm, irregular, white, firm mass was identified extending from the left dorsolateral aspect of the L6 vertebrae to the sacrum, crossing the sacroiliac joint to the ilium, and reaching the acetabulum without affecting the joint cartilage. Tumor masses were also present bilaterally near the costochondral junction of several ribs. White, soft nodules were present in the heart, pericardium, lungs, spleen, and kidneys as well. Histologically, osteolysis with disruption of the cortical bone and reactive bone with the presence of multinucleated osteoclasts was noted. Neoplastic cells consisted of variable, small basophilic round cells (SBRC) with very scant cytoplasm, larger polygonal cells with abundant eosinophilic cytoplasm, and vacuolated cells resembling adipocytes. Within the marrow cavity, vacuolated cells with necrosis predominated, whereas in periosteal areas, polygonal and vacuolated cells that were mixed with a lower percentage of SBRC were more common. In the lungs and heart, SBRC predominated, and in the spleen, polygonal cells were more numerous. Tumor cells stained positive for vimentin and S-100 and stained negative for CD99, neuron-specific enolase, synaptophysin, chromogranin A, cytokeratins, desmin, myoglobin, and actin. This tumor most likely arose from the marrow cavity of the L6 and later invaded through the vertebral body into adjacent vertebrae and various visceral sites.

Animals↗
PubMed2004

Expanding the armamentarium for the spondyloarthropathies.

Ankylosing spondylitis (AS) is a member of the family of spondyloarthropathies, which are inflammatory arthritides largely involving the axial skeleton and commonly accompanied by peripheral arthritis. Genetic factors, particularly the presence of HLA-B27, are major contributors to the susceptibility for AS. Despite some therapeutic advances, the treatment options for patients with AS and related disorders have been limited. Several lines of evidence have led to the hypothesis that patients with AS might benefit from treatment with tumor necrosis factor (TNF). Specifically, TNF concentrations are known to be significantly elevated in the synovium of patients with rheumatoid arthritis (RA), in the inflamed gut of patients with inflammatory bowel disease, and in the inflamed sacroiliac joints of patients with AS. The anti-TNF agents have been shown to be of benefit in, and currently have indications for, RA (etanercept, infliximab, adalimumab), Crohn's disease (infliximab), and psoriatic arthritis (etanercept). Because the spondyloarthropathies share pathogenetic mechanisms with the above-specified disease states, studies have been conducted to evaluate the effectiveness of anti-TNF agents in several disorders, including AS. Data from clinical trials so far with infliximab and etanercept show that patients with AS and related disorders achieve significant improvement in clinical signs and symptoms based on validated outcomes measures. Computed tomography and magnetic resonance imaging (MRI) can facilitate the early diagnosis of AS. Studies with infliximab using MRI together with updated scoring methods demonstrated significant decreases in associated spinal inflammation. TNF antagonist therapy is well tolerated in patients with AS, with a side effect profile consistent with the prior experience of patients with RA.

Antirheumatic Agents↗
PubMed2006

Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease which affects primarily the sacroiliac joints and the spine. In patients with active disease, magnetic resonance imaging (MRI) of the spine shows areas of bone marrow edema, the histopathological equivalent of which is unknown. In this study we correlate inflammation in the spine of patients with AS as revealed by histological examination with bone marrow edema as detected by MRI. We have compared the histopathological findings of zygapophyseal joints from 8 patients with AS (age: 30 to 64, disease duration 7 to 33 years) undergoing spinal surgery with findings in MRI. For histopathological analysis, we quantified infiltrates of CD3+, CD4+ and CD8+ T cells as well as CD20+ B cells immunohistochemically. Bone marrow edema was evaluated in hematoxylin and eosin stained sections and quantified as the percentage of the bone marrow area involved. All patients with AS showed interstitial mononuclear cell infiltrates and various degrees of bone marrow edema (range from 10% to 60%) in histopathological analysis. However, in only three of eight patients histopathological inflammation and edema in the zygapophyseal joints correlated with bone marrow edema in zygapophyseal joints of the lumbar spine as detected by MRI. Interestingly, two of these patients showed the highest histological score for bone marrow edema (60%). This first study correlating histopathological changes in the spine of patients with AS with findings in MRI scans suggests that a substantial degree of bone marrow inflammation and edema is necessary to be detected by MRI.

Adult↗
PubMed1998

Bone metastases in patients with gastrinomas: a prospective study of bone scanning, somatostatin receptor scanning, and magnetic resonance image in their detection, frequency, location, and effect of their detection on management.

PURPOSE: To determine whether bone scan, magnetic resonance imaging (MRI), or somatostatin receptor scintigraphy (SRS) is best for identifying bone metastases in patients with gastrinomas, as well as their frequency and location, whether their detection affects management, and what patient subgroups should be examined. MATERIALS AND METHODS: One hundred fifteen patients with gastrinoma were prospectively studied. Patients were examined yearly and those with liver metastases were reexamined every 3 months. Based on clinical history, histology, growth pattern, and development of new bone lesions, possible bone metastases were classified as to whether they were or were not bone metastases. Imaging results were correlated at different times in the disease course and with disease extent. RESULTS: Bone scan was positive in 52 patients, MRI in seven, and SRS in six. Eight patients (7%) were determined to have bone metastases and MRI was correctly positive in seven, SRS in six, and bone scan in five. SRS or MRI was positive in all patients with bone metastases. Bone scan had significantly lower specificity and sensitivity, and a higher rate (P < .02) of false-negative results than MRI or SRS. Bone metastases occurred in 31% of patients with liver metastases and 0% with only lymph node metastases. The initial bone metastases were in the spine or sacrum (75%) followed in descending order by the pelvis or sacroiliac joints (38%), scapula or shoulder, and ribs. In all cases, detection of bone metastases changed the management. CONCLUSION: SRS and MRI, because of high sensitivity and specificity, are recommended over bone scanning to screen for bone metastases in patients with gastrinomas. However, because bone metastases can occur initially outside the axial skeleton, SRS is the recommended initial localization method of choice. Bone metastases occur in 7% of all patients and 31% of patients with liver metastases, only occur in patients with liver metastases, are usually in the axial skeleton initially, and their detection changes management in all cases. Patients with pancreatic endocrine tumors with liver metastases should undergo SRS every 6 months to 1 year to detect bone metastases.

Adolescent↗
PubMed2003

The effect of saddle design on stresses in the perineum during cycling.

PURPOSE: Repetitive internal stress in the perineum has been associated with soft-tissue trauma in bicyclists. Using an engineering approach, the purpose of this study was to quantify the amount of compression exerted in the perineum for a range of saddle widths and orientations. METHODS: Computer tomography was used to create a three-dimensional voxel-based finite element model of the right side of the male perineum-pelvis. For the creation of the saddle model, a commercially available saddle was digitized and the surface manipulated to represent a variety of saddle widths and orientations. The two models were merged, and a static downward load of 189 N was applied to the model at the region representing the sacroiliac joint. For validation purposes, external stresses along the perineum-saddle interface were compared with the results of pressure sensitive film. Good agreement was found for these external stresses. The saddles were then stretched and rotated, and the magnitude and location of maximum stresses within the perineum were both recorded. In all cases, the model of the pelvis-perineum was held in an upright position. RESULTS: Stresses within the perineum were reduced when the saddle was sufficiently wide to support both ischial tuberosities. This supporting mechanism was best achieved when the saddle was at least two times wider than the bi-ischial width of the cyclist. Stresses in the anterior of the perineum were reduced when the saddle was tilted downward, whereas stresses in the posterior were reduced when the saddle was tilted upward. CONCLUSIONS: Recommendations that saddles should be sufficiently wide to support the ischial tuberosities appear to be well founded. Recommendations that saddles be tilted downward (i.e., nose down) are supported by the model, but with caution, given the limitations of the model.

Animals↗
PubMed1986

Cartilage-cell-containing tumours of the pelvis: a radiological review of 40 patients.

Cartilage-cell-containing tumours of the pelvis are responsible for a quarter of all primary bone lesions in this site. Benign tumours are uncommon but when present have classical radiological appearances similar to those described elsewhere. Only the rarest, chondromyxoid fibroma, may cause difficulty in diagnosis. Seventy-three per cent of cartilage-cell tumours are malignant and are either chondrosarcoma or chondroblastic osteosarcoma. Chondrosarcoma occurs after the second decade of life, usually with a longer history, and may be categorised as either a secondary peripheral or primary central tumour, each having typical radiological features. Chrondroblastic osteosarcoma tends to occur in younger patients with a shorter clinical history and is almost exclusively situated adjacent to a sacroiliac joint, producing purely lytic, sclerotic or mixed patterns of bone destruction. Experience suggests that computed tomography is the single most valuable further examination, since the pelvis is a complex structure with confusing overlying soft-tissue artefacts. This technique may indicate both the route and choice of optimal biopsy site.

Adolescent↗
PubMed2005

Surgical treatment and outcome of conventional pelvic chondrosarcoma.

We reviewed 124 patients with a conventional pelvic chondrosarcoma who had been treated over a period of 20 years. We recorded the type of tumour (central or peripheral), type of operation (limb salvage surgery or hemipelvectomy), the grade of tumour, local recurrence and/or metastases, in order to identify the factors which might influence survival. More satisfactory surgical margins were achieved for central tumours or in those patients treated by hemipelvectomy. However, grade 1 tumours, whatever the course, did not develop metastases or cause death, while grade 3 tumours had the worst outcome and prognosis. Central, high-grade tumours require aggressive surgical treatment in order to achieve adequate surgical margins, particularly in those lesions located close to the sacroiliac joint. By contrast, grade 1 peripheral chondrosarcomas may be treated with contaminated margins in order to reduce operative morbidity, but without reducing survival.

Bone Neoplasms↗