RESUMEN
Percutaneous image-guided radiofrequency ablation is mainly used for treatment of tumours in the skeleton, the liver, kidney and lung, in patients who are no (longer) candidates for surgical treatment. Sterile placement of the radiofrequency electrode, which is coupled to a radio-frequency generator, is image-guided. Heating causes cell-death. It has been shown in the literature that radiofrequency ablation is a safe and effective treatment method for local tumor control.
Asunto(s)
Ablación por Catéter/métodos , Neoplasias Renales/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/cirugía , Adulto , Ablación por Catéter/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Patient and staff dose during CT guided coagulation of osteoid osteoma, tissue biopsy and abscess drainage were evaluated retrospectively on a conventional CT scanner and prospectively on a scanner equipped with fluoroscopic CT. The computed tomography dose index (CTDI) and the individual dose equivalent, i.e. the penetrating dose for workers at a depth of 10 mm tissue, were measured. Evaluation of CTDI enabled effective dose and maximum skin entrance doses for the patient to be determined. Doses were assessed for 96 CT guided interventions, including 16 drainages with average effective doses of 13.5 mSv and 9.3 mSv for the conventional CT scanner and the scanner with spiral CT fluoroscopy, respectively, 49 biopsies (effective doses of 8 mSv and 6.1 mSv, respectively), and 31 coagulations of osteoid osteoma (effective doses of 2.1 mSv and 0.8 mSv, respectively). Effective doses to patients were in the same range as those observed for regular diagnostic CT examinations. Entrance skin doses were well below the 2 Gy threshold for deterministic skin effects on the CT scanner equipped with fluoroscopic function (0.03-0.33 Gy), whilst skin doses on the conventional scanner were considerably higher (0.09-1.61 Gy). This is mainly owing to the fact that on the conventional scanner mAs was rarely reduced for scans evaluating needle position whereas low mAs per rotation was selected on the scanner with the fluoroscopy option. The maximum dose to a worker measured outside the lead apron was 28 microSv for one single procedure. The mean dose per procedure was below 10 microSv for radiologists and below 1 microSv for radiographers. Correcting for attenuation of the lead apron, the doses to workers are very low.
Asunto(s)
Exposición Profesional , Dosis de Radiación , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Biopsia , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Drenaje , Electrocoagulación , Fluoroscopía , Humanos , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Radiometría/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. CASE DESCRIPTION: Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. Indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. OUTCOMES: After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up. DISCUSSION: There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.
Asunto(s)
Bursitis/terapia , Modalidades de Fisioterapia/métodos , Articulación del Hombro , Adulto , Anciano , Bursitis/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
STUDY DESIGN: Two cases are reported in which an osteoid osteoma of the lumbar spine was treated with CT-guided thermocoagulation. OBJECTIVES: To review an alternative and minimally invasive treatment for spinal osteoid osteomas. SUMMARY OF BACKGROUND DATA: Surgical resection of a spinal osteoid osteoma can, depending on the location, be a formidable undertaking. Bone scintigraphy can be helpful in intraoperative identification. More recently, resection through a computed tomography-guided drill hole was found to minimize exposure. Using a thermocoagulation probe, as has been used in osteoid osteoma of the extremities, may be technically easier and cause less morbidity. METHOD: With the patient under general anesthesia, a bone biopsy cannula was introduced into the center of the osteoid osteoma. Material was subjected to histologic examination. A thermocoagulation probe was then inserted and heated to 90 C for 4 minutes. The two patients were kept overnight for observation. RESULTS: Both patients had complete pain relief and no evidence of recurrence after 2 years' follow-up. There were no complications. Scoliosis resolved in one patient and persisted in the other. CONCLUSION: Percutaneous computed tomography-guided thermocoagulation is a minimally invasive and technically straightforward method to achieve ablation of a spinal osteoid osteoma. No complications were encountered in these two patients. Future research should focus on the safety of thermocoagulation, especially cephalad to the level of the conus medullaris.
Asunto(s)
Electrocoagulación , Osteoma Osteoide/terapia , Neoplasias de la Columna Vertebral/terapia , Adolescente , Adulto , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Mínimamente Invasivos , Osteoma Osteoide/complicaciones , Osteoma Osteoide/diagnóstico por imagen , Escoliosis/etiología , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Dislocation of the elbow joint is the second most common dislocation in the upper extremity, dislocation of the shoulder being the most common. It has been reported that uncomplicated dislocation of the elbow joint may be associated with a decreased range of motion, degenerative changes in the elbow joint, ectopic calcification, or neurological deficits. As the medial collateral ligament complex can be completely disrupted during dislocation, we evaluated the association between the long-term results of treatment of simple posterolateral dislocation of the elbow and the presence of persistent medial or valgus elbow instability. METHODS: Fifty patients who had a mean age of thirty-three years (range, eighteen to fifty-eight years) had closed reduction of a posterolateral dislocation of the elbow without associated fractures. The extremity was immobilized in an above-the-elbow plaster cast for three weeks. After a mean duration of follow-up of nine years (range, six to thirteen years), forty-one patients were evaluated with an interview, a physical examination, and radiographs made while a valgus load was applied to the elbow. RESULTS: The average score according to the system of The Hospital for Special Surgery was 91 points (range, 49 to 100 points), and thirty-one patients described their elbow function as good or excellent. Twenty-four patients had evidence of medial instability on radiographs made while a valgus load was applied to the elbow. Twenty-one patients had signs of degeneration of the joint, and twenty-five patients had ectopic ossification. Magnetic resonance imaging combined with arthrography was performed for the first twenty patients; eight had evidence of rupture of the medial collateral ligament, seven had generalized degenerative changes of the cartilage, and four had a chondral defect of the capitellum. (The study could not be completed for the remaining patient.) Medial instability on radiographs was correlated with signs of degeneration (p = 0.001), ectopic ossification (p = 0.01), a worse score according to the system of The Hospital for Special Surgery (p = 0.002), and persistent pain (p = 0.04). CONCLUSIONS: Posterolateral dislocation of the elbow joint can lead to persistent valgus instability that is associated with a worse overall clinical and radiographic result.
Asunto(s)
Lesiones de Codo , Luxaciones Articulares/etiología , Inestabilidad de la Articulación/etiología , Adulto , Moldes Quirúrgicos , Ligamentos Colaterales/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Luxaciones Articulares/terapia , Inestabilidad de la Articulación/fisiopatología , Masculino , Factores de TiempoRESUMEN
Medial discomfort of the elbow in athletes can be due to valgus instability after acute ligament rupture or attenuation of the medial collateral ligament caused by repetitive microtrauma during overhead throwing. We studied 16 athletes with medial instability of the elbow due to insufficiency of the medial collateral ligament. 4 patients had sensory ulnar nerve symptoms, of whom 2 had abnormalities of the ulnar nerve on electromyography. 13 showed an increase in the ulno-humeral joint space on dynamic radiography under valgus load. MRI of 10 of these 13 elbows revealed rupture of the medial collateral ligament or avulsion of the medial collateral ligament. Dynamic radiography under valgus load seems to be of value for the diagnosis of chronic medial collateral ligament insufficiency.
Asunto(s)
Traumatismos en Atletas/diagnóstico por imagen , Articulación del Codo , Inestabilidad de la Articulación/diagnóstico por imagen , Ligamentos Articulares/lesiones , Adulto , Traumatismos en Atletas/fisiopatología , Fenómenos Biomecánicos , Femenino , Humanos , Inestabilidad de la Articulación/fisiopatología , Masculino , Radiografía , Rotura , Nervio Cubital/fisiopatologíaRESUMEN
Measurements made from radiographs of the shoulder are often used for evaluation of the position of a shoulder prosthesis after surgery. The distances measured from a radiograph are subject to projection errors arising from positioning of the patient in front of the x-ray cassette and from the direction of the x-ray beam at the time of the exposure. The projection error was studied on radiographs of the glenohumeral joint in cadaver preparations. Measurements of the spatial relationship between the glenohumeral joint and the scapula changed by 10% to 50% when the specimen was rotated by 20 degrees around an axis through the glenohumeral joint. The values measured on radiographs of the proximal humerus changed by less than 10% when the humerus was rotated by 20 degrees (exorotation and endorotation). Proposals are made for specific measurements in evaluating the shoulder before and after a prosthesis is implanted.
Asunto(s)
Articulación del Hombro/diagnóstico por imagen , Anciano , Antropometría , Cadáver , Femenino , Humanos , Húmero/anatomía & histología , Húmero/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Ajuste de Prótesis , Radiografía/métodos , Articulación del Hombro/anatomía & histologíaRESUMEN
The Putti-Platt capsulorraphy for recurrent anterior dislocation of the glenohumeral joint was performed in 139 shoulders between 1955 and 1985. Sixty-six (46%) operated shoulders were studied with a mean follow-up period of 22 years (range 10 to 40 years). There were 52 shoulders of men and 14 shoulders of women; 45% of the shoulders were on the dominant side. Two patients underwent surgery on both shoulders. The average age of the patients was 49.3 years (range 33 to 74 years). Evaluation was based on patient history and the results of physical examination and radiography. The redislocation rate was low (only 3%), and 71% of the patients did not have pain, strength loss, stiffness, or instability in the operated shoulder. Radiographs were made of all shoulders, including the nonoperated shoulders. Osteoarthrotic changes of the glenohumeral joint were found in 40 (61%) shoulders. Arthrosis was mild in 23 (35%) shoulders, moderate in 13 (20%) shoulders, and severe in 4 (6%) shoulders. The rate of glenohumeral arthrosis is increased in patients who have undergone a Putti-Platt procedure and is positively correlated with the length of time since surgery. No correlation was found in this study between external rotation at 6 months after operation and the development of glenohumeral arthrosis. The number of dislocations before operation was correlated with the severity of arthrosis but not with its incidence.
Asunto(s)
Procedimientos Ortopédicos , Osteoartritis/etiología , Luxación del Hombro/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Húmero/patología , Húmero/cirugía , Masculino , Persona de Mediana Edad , Dolor , Rango del Movimiento Articular , Luxación del Hombro/patología , Articulación del Hombro/patologíaRESUMEN
We reviewed eight children (ten shoulders) who had suffered neonatal sepsis, after a mean follow-up of 14 years (11 to 15). The delay between the onset of symptoms and diagnosis was one day in five patients, two days in three and seven days in one. All ten shoulders were treated by aspiration, followed by arthrotomy in two. At follow-up, five of the ten shoulders had a full range of movement and the others had minimal restriction of external rotation. Shortening of 10 cm was present in one patient, while two with bilateral involvement had disproportionally short humeri. Early diagnosis and treatment favour the outcome in septic arthritis of the shoulder. With late diagnosis, deformation of the humeral head and shortening of the humerus cause marked cosmetic abnormality but negligible functional loss.
Asunto(s)
Artritis Infecciosa/complicaciones , Articulación del Hombro/microbiología , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/cirugía , Enfermedades Óseas/diagnóstico por imagen , Enfermedades Óseas/etiología , Enfermedades Óseas/fisiopatología , Estética , Estudios de Seguimiento , Placa de Crecimiento/diagnóstico por imagen , Placa de Crecimiento/crecimiento & desarrollo , Placa de Crecimiento/patología , Humanos , Húmero/diagnóstico por imagen , Húmero/crecimiento & desarrollo , Húmero/patología , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/patología , Rango del Movimiento Articular/fisiología , Rotación , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/fisiopatología , Articulación del Hombro/cirugía , Succión , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We re-examined clinically and radiologically 88 patients with a fracture of the lower leg at a mean follow-up of 15 years. Forty-three fractures (49%) had healed with malalignment of at least 5 degrees. More arthritis was found in the knee and ankle adjacent to the fracture than in the comparable joints of the uninjured leg. Malaligned fractures showed significantly more degenerative changes. Eighteen patients (20%) had symptoms in the fractured leg. There was a significant correlation between symptoms in the knee and arthritis but not between symptoms and ankle arthritis or malalignment. We conclude that fractures of the lower leg should be managed so that the possibility of angular deformity and thereby late arthritis is minimised.
Asunto(s)
Articulación del Tobillo , Fracturas Mal Unidas/complicaciones , Articulación de la Rodilla , Osteoartritis/etiología , Fracturas de la Tibia/complicaciones , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Fracturas Mal Unidas/clasificación , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/clasificación , Osteoartritis/diagnóstico por imagen , Radiografía , Índice de Severidad de la Enfermedad , Fracturas de la Tibia/clasificaciónRESUMEN
Seven wrists are presented with a septum connecting the lunotriquetral interosseous ligament and triangular fibrocartilage, resulting in bicompartmentalization of the radiocarpal joint. In all of the 7 wrists, having no history of trauma, the septums were suspected to be of congenital origin. The histopathology of the septum in 1 cadaver wrist showed a fibrocartilaginous structure. Two types of radiocarpal joint bicompartmentalization were identified by arthrography. Type 1 (2 wrists) had a septum with normal (intact) lunotriquetral interosseous ligament, and type 2 (5 wrists) had a septum with a communicating defect of the lunotriquetral interosseous ligament. The septum is most likely a congenital malformation caused by a disturbance of the vacuolization of the mesenchymal mass between the forearm and carpus.
Asunto(s)
Huesos del Carpo/anomalías , Ligamentos Articulares/anomalías , Articulación de la Muñeca/anomalías , Adulto , Huesos del Carpo/diagnóstico por imagen , Femenino , Humanos , Ligamentos Articulares/diagnóstico por imagen , Masculino , Radiografía , Estudios Retrospectivos , Articulación de la Muñeca/diagnóstico por imagenAsunto(s)
Neoplasias Óseas/cirugía , Huesos del Carpo/cirugía , Osteocondroma/cirugía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/patología , Diagnóstico Diferencial , Exostosis/diagnóstico por imagen , Exostosis/patología , Exostosis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Osteocondroma/diagnóstico por imagen , Osteocondroma/patología , RadiografíaRESUMEN
The general principles of judging wrist injuries are discussed. Carefully made standard views will provide recognizable projections of carpal bones in order to judge abnormal positions. Additional views, conventional tomography and CT scans are, in some instances, necessary to diagnose fractures. For ligamentous damage resulting in carpal instability, fluoroscopy of the wrist and/or an arthrogram should be obtained. Examples of difficult pathology are shown and variations or more or less borderline pathology as coincidental findings are discussed. The main pitfalls are: wrong diagnosis made on inappropriately taken radiographs; misinterpretation of carpal bone relationships; and overestimation of some arthrographically found abnormalities.
Asunto(s)
Traumatismos de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/lesiones , Errores Diagnósticos , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , RadiografíaRESUMEN
The technique of CT arthrography and arthrotomography of the major joints is discussed. Also, the types of contrast media, double or single contrast technique, film-screen combinations, injection techniques and additional pain testing are discussed.
Asunto(s)
Artrografía , Tomografía Computarizada por Rayos X , Artrografía/métodos , Humanos , Tomografía Computarizada por Rayos X/métodosRESUMEN
To improve visibility of the interosseous ligaments at magnetic resonance (MR) imaging of the wrist, the authors made and tested a device to apply ulnar and radial stress. In two men with small lunotriquetral (n = 1) and scapholunate (n = 1) ligament defects, depiction became evident only with stress deviation. Stress testing with this device increased the diagnostic accuracy of MR imaging for detection of these lesions.
Asunto(s)
Huesos del Carpo/patología , Ligamentos/patología , Imagen por Resonancia Magnética , Adulto , Diseño de Equipo , Humanos , Ligamentos/lesiones , Hueso Semilunar/patología , Imagen por Resonancia Magnética/instrumentación , Masculino , Osteonecrosis/diagnóstico , Radio (Anatomía)/patología , Rotura , Estrés Mecánico , Cúbito/patologíaRESUMEN
Current treatment for osteoid osteomas is usually surgical excision of the nidus. We treated 18 patients with osteoid osteoma by percutaneous thermocoagulation of the nidus under computed-tomography guidance. The procedure was technically successful in all cases and there were no complications. Patients were discharged on the following morning and resumed normal activities immediately. All patients but one remained pain free during follow-up (range 3-15 months). A second thermocoagulation treatment relieved the recurrent symptoms in this patient. Percutaneous thermocoagulation appears to be effective for osteoid osteomas, and is a minimally invasive alternative to surgical resection.
Asunto(s)
Neoplasias Óseas/cirugía , Electrocoagulación , Osteoma Osteoide/cirugía , Tomografía Computarizada por Rayos X , Neoplasias Óseas/diagnóstico por imagen , Humanos , Osteoma Osteoide/diagnóstico por imagenRESUMEN
RATIONALE AND OBJECTIVE: To optimize screen-film combinations for equalization radiography (advanced multiple beam equalization radiography [AMBER]), five different film-screen-technique combinations were compared by receiver operating characteristics study of simulated interstitial disease. MATERIALS AND METHODS: The Ortho C-Lanex Regular and the Insight Thoracic Imaging HC system were compared in conventional nonequalized technique; T-Mat G-Lanex Regular and T-Max L-Lanex Regular were compared in conventional, nonequalized, and AMBER technique; and an experimental high-contrast, low-noise, near-zero crossover film-screen combination was compared in AMBER technique. Interstitial disease was simulated by superimposing birdseed on the back of a humanoid phantom. Twenty-five posterior-anterior radiographs were made with each technique. Seven observers scored the presence of interstitial disease in each of the quadrants on a 5-point scale following receiver operating characteristic methodology. RESULTS: The highest performance was found with the experimental film-screen-AMBER combination (Az = 0.92) and the lowest with the T-Mat L-Lanex Regular-AMBER combination (Az = 0.83) and the Insight Thoracic Imaging HC system-conventional combination (Az = 0.85). T-Mat L-Lanex Regular-conventional ranked second (Az = 0.90) while T-Mat G-Lanex Regular-conventional (Az = 0.89), T-Mat L-Lanex Regular-AMBER (Az = 0.88) and Ortho-C-Lanex Regular-conventional (Az = 0.87) scored lower. CONCLUSION: Higher contrast films in AMBER improve diagnostic performance, whereas a loss of information is found if the AMBER system is combined with lower contrast films.
Asunto(s)
Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Radiografía Torácica/métodos , Pantallas Intensificadoras de Rayos X , Humanos , Modelos Estructurales , Curva ROCRESUMEN
The long deltopectoral approach promoted by Neer is the standard for performing a total shoulder arthroplasty. However, this exposure is inadequate for preparation and bone grafting of the glenoid cavity or repairing an associated large rotator cuff tear. In the anatomy laboratory we looked for an alternative approach to the glenohumeral joint which would accommodate these difficulties. Afterwards we used this approach in 7 of 13 patients in whom a Biomet Bio-modular shoulder arthroplasty was planned. The study is prospective with a 1-year follow-up of 12 cases.
Asunto(s)
Artritis Reumatoide/cirugía , Prótesis Articulares , Articulación del Hombro/cirugía , Anciano , Artroplastia/métodos , Trasplante Óseo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Estudios Prospectivos , Manguito de los Rotadores/cirugíaRESUMEN
We report the long-term results of the Matti-Russe operation for pseudarthrosis of the scaphoid in 100 cases, reported previously by Mulder in 1968. Clinical results for 77 patients and radiographic data for 74 were reviewed at 22 to 34.8 years after surgery. In general, there was satisfactory relief of pain and stiffness but some patients had limitation of motion and reduced grip-strength, with usually slight osteoarthritic changes. There was poor correlation between subjective, objective, and radiographic results but 88% of the patients were satisfied with their results.