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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We used MRI to examine the hips of 32 asymptomatic patients at 9 to 21 months after renal transplantation covered by high-dose corticosteroids. Five hips in three patients showed changes which indicate avascular necrosis, although radiographs, CT scans and isotope scans were normal. These patients had repeat MRI scans after another two years and three years. One patient with bilateral MRI changes developed symptoms and abnormal radiographs and CT and isotope scans in one hip nine months after the abnormal MRI. Intraosseous pressure was found to be raised in both hips, and core biopsies revealed necrotic bone on both sides. The other three hips have remained asymptomatic with unchanged MRI appearances three years after the initial MRI. It seems that idiopathic avascular necrosis does not always progress to bone collapse in the medium term.
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PMID:Early detection of avascular necrosis of the femoral head by MRI. 817 76

The clinical features, investigation and outcome in 24 patients with pregnancy-associated osteoporosis, followed for up to 24 years from the first pregnancy are described. Symptoms occurred most often in the first pregnancy (17 patients) at a mean age of 27 years (range 21-36); the most frequent was back pain in late pregnancy or post partum (n = 18); less common was hip (n = 5) or ankle (n = 1) pain. In most, symptoms improved soon after delivery. Four subjects had pre-existing disorders known to reduce bone density (corticosteroid therapy, heparin treatment, mild osteogenesis imperfecta and previous anorexia nervosa). Radiographs showed vertebral collapse or localized osteoporosis of the hip, with MRI evidence of oedema. Forearm bone mineral density (BMD) was sometimes normal, but spinal BMD (measured by DXA) was low. Bone biopsies in eleven patients showed features compatible with osteoblast failure. Except for the patient with mild osteogenesis imperfecta, cultured dermal fibroblasts synthesized and exported normal Type I collagen. In 14 subsequent pregnancies (10 patients) there was no recurrence in ten and mild symptoms in the remainder. Excluding one patient who had repeated osteoporotic fractures and vertebral collapse, the long-term prognosis was good.
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PMID:Pregnancy-associated osteoporosis. 859 46

Efficacious management of patients with avascular necrosis of bone (AVN) necessitates the identification of patients with a high risk of collapse of the femoral head. In this prospective study we imaged both hips of 10 patients with active rheumatoid arthritis, who were treated with methylprednisolone pulse therapy. MRI and conventional radiography were performed before MP-pulse therapy and 6 and 12 months thereafter. Two patients showed unilateral changes, compatible with AVN. One patient became symptomatic and revealed characteristic radiographic abnormalities. The other patient remained asymptomatic and the MRI appearance returned to normal after 6 months.
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PMID:Magnetic resonance imaging of the femoral head to detect avascular necrosis in active rheumatoid arthritis treated with methylprednisolone pulse therapy. 861 70

We have carried out a prospective study of 17 patients (14 women, 3 men) of mean age 48 years (21 to 76) with transcervical fractures of the femur using MRI to detect early evidence of avascular necrosis of the head. Two fractures were Garden stage I, 12 stage II, and three stage III. We performed internal fixation under radiological control at a mean of five days (2 to 15) after injury using a titanium cannulated cancellous screw or a titanium compression hip screw. MRI was performed at one, six and 12 months and then yearly after operation. T1- and T2-weighted images were obtained by a spin-echo technique. The duration of follow-up of patients who did not subsequently require replacement of the head of the femur was from 2 to 5 years (mean 3.2). One month after operation eight of the 17 hips showed a band of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images indicating lesions in the femoral head away from the fracture line. These were of three types: type I was a small infarct at the superolateral region of the femoral head and was seen in three hips; type II was a shallow lesion from the superolateral region to the fovea of the femoral head (three hips); and type III was a large lesion occupying most of the femoral head (two hips). No further changes were seen in the MRI after six months from operation. Collapse of the femoral head did not occur in the three hips with type-I lesions, but two of the three type-II hips and both type-III hips subsequently collapsed. At the final follow-up the three hips with a type-I lesion and one with a type-II were still asymptomatic but radiography showed sclerosis in the femoral head corresponding to the MRI lesions. The nine hips which showed no changes on MRI at one month had no abnormal findings on physical examination, radiography or MRI at final follow-up.
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PMID:MRI of early osteonecrosis of the femoral head after transcervical fracture. 866 37

A 79-year-old Afro-Caribbean woman presented with a 5-month history of low back pain and a 2-month history of weakness of the lower limbs associated with cauda equina syndrome. A plain X-ray of the lumbar spine showed a collapse of the L4 body consistent with osteomyelitis. An MRI scan of the lumbar spine showed narrowing of the L3/4 disc space, destruction of the adjacent vertebral bodies and an epidural abscess. She was admitted to hospital and treated with a high dose of i.v. antibiotics followed by radical surgical excision of the lesion through a combined anterior and posterior approach with instrumentation. Tissue culture grew Streptococcus milleri. One week after surgery the patient developed septicaemia. A blood culture grew Pseudomonas aeruginosa, which was successfully treated with antibiotics. She eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Streptococcus milleri is a rare causative organism in osteomyelitis, this being only the eighth reported case in the literature. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result.
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PMID:Cauda equina syndrome secondary to lumbar spondylodiscitis caused by Streptococcus milleri. 872 96

Eighty cases of surgically treated syringomyelia were retrospectively reviewed. The cases were classified into following 4 types, type 1: syringomyelia with Chiari malformation (54 cases), type 2: syringomyelia with basal arachnoiditis (15 cases), type 3: syringomyelia with an obstruction of the foramen Magendie (1 case), and type 4: syringomyelia with spinal arachnoiditis (14 cases). Foramen magnum decompression (FMD) was performed in patients with type 1, in type 2 fourth ventricle-subarachnoid shunt was additionally performed. Gardner's operation was performed in patients with type 3. Syrinx-peritoneal shunt was performed in patients with type 4. Surgical procedures for syringomyelia which we selected were thought to be appropriate, based on postoperative syrinx collapse rate in MRI. However, postoperative clinical course was much different in each type of syringomyelia after the collapse of syrinx had been equally achieved. Neurological disorders were stopped in deterioration after surgery in all cases of type 1. However, motor weakness was still deteriorated in half cases of type 2, and in 60% of type 4. When clinical severity of the patients with type 1 and 2, based on the distribution of dissociated sensory loss and motor weakness, were classified into 5 grades. The rate of improvement of patient's symptoms and signs was higher in the lower grades. We concluded that a surgical treatment for syringomyelia was essentially a preventive one, therefore it should be done in early stage of disorders.
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PMID:[Surgical treatment of syringomyelia]. 875 12

The clinical management of patients with skeletal metastases puts new demands on imaging. The radiological imaging in screening for skeletal metastases entails detection, metastatic site description and radiologically guided biopsy for morphological typing and diagnosis. Regarding sensitivity and the ease in performing surveys of the whole skeleton, radionuclide bone scintigraphy still is the first choice in routine follow-up of asymptomatic patients with metastatic disease of the skeleton. A negative scan has to be re-evaluated with other findings, with emphasis on the possibility of a false-negative result. Screening for metastases in patients with local symptoms or pain is best accomplished by a combination of radiography and MRI. Water-weighted sequences are superior in sensitivity and in detection of metastases. Standard spin-echo sequences on the other hand are superior in metastatic site description and in detection of intraspinal metastases. MRI is helpful in differentiating between malignant disease, infection, benign vertebral collapse, insufficiency fracture after radiation therapy, degenerative vertebral disease and benign skeletal lesions. About 30% of patients with known cancer have benign causes of radiographic abnormalities. Most of these are related to degenerative diseases and are often easily diagnosed. However, due to overlap in MRI characteristics, bone biopsy sometimes is essential for differentiating between malignant and nonmalignant lesions. Performing bone biopsy and aspiration cytology by radiologist and cytologist in co-operation has proven highly accurate in diagnosing bone lesions. The procedure involves low risk to the patient and provides a morphological diagnosis. Once a suspected metastatic lesion is detected, irrespective of modality, the morphological diagnosis determines the appropriate work-up imaging with respect to the therapy alternatives. The integration of multimodality imaging in the assessment of skeletal metastases is complex and requires multidiciplinary co-operation in order to optimize screening and medical clinical care with respect to the prognosis and life quality of patients with bone metastatic disease.
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PMID:Radiological diagnosis of skeletal metastases. 893 20

The authors report their experience in the surgical management of lesions of the adult hip following radiotherapy. The diagnosis of a hip problem occurring after pelvic radiotherapy for malignant tumors is made by clinical and radiological examination. The problems include femoral head necrosis, necrosis and/or fracture of the acetabulum, or involvement of the entire hip joint (radiation coxopathy). Fractures of the femoral neck have been described in the literature, but are now very rare following the routine use of external shields as protection during irradiation. Post-irradiation lesions are often bilateral 21%. They appear after a variable latency period of two to twenty years and they progress remorselessly. A diagnosis of simple radio necrosis can only be made after using radio isotope bone scanning, MRI or CT to exclude malignant disease as acetabular metastasis, and radio-induced sarcomas. Hemiarthroplasty is often followed by collapse of the acetabulum and should no longer be used. The treatment generally practised nowadays is a Total Hip Replacement (THR). We report a retrospective study of 71 hips in 56 patients treated, between 1970 and 1982, by the use of conventional cemented components. In 49 hips this was followed by a 52% incidence of acetabular loosening resulting from the poor quality of the irradiated bone which had become necrotic and porotic. Between 1983 and 1990, we modified the technique by regularly using reinforcing the acetabulum with a metallic ring fixed by long screws, (as used in revision surgery for THR). Bone grafts were also used in 9 cases. We had a 12% incidence of loosening in 22 hips with a mean follow-up of 40 months. There were also two post-operative infection which need removal of the prostheses. This emphasizes the risk of infection in this type of surgery and is probably increased by the associated lesions of the soft tissues (lymphoedema, radiodermitis). The authors wish to stress the poor prognosis of radiation lesions of the hip which often occur in patients who have otherwise recovered from their pelvic tumour. These radiation lesions have to be recognised and treated in a specific way. Our experience and the reports in the literature suggest that the generally used conventional THR gives uncertain results, and therefore we propose a THR employing metallic reinforcement of the acetabulum with or without any necessary bone grafts. It is vital to warn the patients that the results may not be as excellent as with THR for other types of hip disorders. When there is severe destruction of the acetabulum the choice between a THR combined with massive bone allograft, and a Girdlestone hip resection must be very carefully discussed with the patient. This latter "salvage" procedure may in any case become necessary if there are local and otherwise unmanageable problems.
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PMID:[Surgical treatment of radiation-induced lesions of the hip in adults]. 913 52

The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip. Often the X-ray photograph leads to the diagnosis in the second stage (ARCO 1992) or in the third stage, when the femoral head has begun to collapse. The stage IIc and III shows an evident enhancement in contrast media in MRI. Contrast enhancement is demonstrated by STIR, FATSAT, T1-weighted and dynamic screening sequence. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head.
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PMID:[Initial nuclear magnetic resonance tomography results of the treatment course of avascular femur head necrosis after femoral core decompression]. 917 68

The objective of this study was to determine the frequency and significance of the MR findings of incomplete shell collapse for detecting implant rupture in a series of surgically removed breast prostheses. MR images of 86 breast implants in 44 patients were studied retrospectively and correlated with surgical findings at explantation. MR findings included (a) complete shell collapse (linguine sign), 21 implants; (b) incomplete shell collapse (subcapsular line sign, teardrop sign, and keyhole sign), 33 implants; (c) radial folds, 31 implants; and (d) normal, 1 implant. The subcapsular line sign was seen in 26 implants, the teardrop sign was seen in 27 implants, and the keyhole sign was seen in 23 implants. At surgery, 48 implants were found to be ruptured and 38 were intact. The MR findings of ruptured implants showed signs of incomplete collapse in 52% (n = 25), linguine sign in 44% (n = 21), and radial folds in 4% (n = 2). The linguine sign perfectly predicted implant rupture, but sensitivity was low. Findings of incomplete shell collapse improved sensitivity and negative predictive values, and the subcapsular line sign produced a significant incremental increase in predictive ability. MRI signs of incomplete shell collapse were more common than the linguine sign in ruptured implants and are significant contributors to the high sensitivity and negative predictive values of MRI for evaluating implant integrity.
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PMID:Intracapsular implant rupture: MR findings of incomplete shell collapse. 924 94


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