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1.
Skeletal Radiol ; 51(1): 219-223, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34331550

RESUMEN

A 57-year-old patient developed severe, persistent pain following MR arthrography with iodinated contrast. MRI 1 week later showed synovitis which was new compared to the prior MRI. Arthroscopy showed severe synovitis. Histopathology showed synovitis characterized by lymphocytes, neutrophils, and necrosis. One out of 4 intraoperative cultures was positive, but ultimately believed to be due to contaminants. CRP normalized within 1 month. Repeat MRI 2 years later showed progressive degenerative findings, but no evidence of ongoing infection, or stigmata of previous infection. We believe this to be an unusually severe case of reactive synovitis. The purpose of the report is to add to knowledge of reactions to intra-articular contrast injection.


Asunto(s)
Artrografía , Medios de Contraste , Sinovitis , Artrografía/efectos adversos , Artroscopía , Medios de Contraste/efectos adversos , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Sinovitis/inducido químicamente , Sinovitis/diagnóstico por imagen
2.
Clin Orthop Relat Res ; 479(1): 151-160, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32701771

RESUMEN

BACKGROUND: Cone beam CT (CBCT) is a widely available technique with possible indications in carpal ligament injuries. The accuracy of CBCT arthrography in diagnosing traumatic tears of the scapholunate ligament has not been reported. QUESTIONS/PURPOSES: (1) What is the diagnostic accuracy of CBCT and how does it relate to the accuracy of multislice CT arthrography and conventional arthrography in diagnosing scapholunate ligament tears? (2) What is the estimated magnitude of skin radiation doses of each method? METHODS: This secondary analysis of a previous prospective study included 71 men and women with suspected scapholunate ligament tears and indications for arthroscopy. Preoperative imaging was conventional arthrography and either MSCT arthrography for the first half of patients to be included (n = 36) or flat-panel CBCT arthrography for the remaining patients (n = 35). Index tests identified therapy-relevant SLL tears with dorsal or complete SLL ruptures, and these tears were compared with relevant SLL tears which were determined through arthroscopy as Geissler Stadium III and IV by probing the instable SL joint with a microhook or arthroscope. These injuries were treated by open ligament repair and Kirschner wire fixation. Accuracy values and 95% confidence intervals were calculated. Additional estimates of the radiation skin doses of each CBCT exam and two MSCT protocols were subsequently calculated using dose area products, dose length products, and CT dose indices. RESULTS: The diagnostic accuracy was high for all imaging methods. 95% CIs were broadly overlapping and therefore did not indicate differences between the diagnostic groups: Sensitivity of CBCT arthrography was 100% (95% CI 77 to 100), specificity was 95% (95% CI 76 to 99.9), positive predictive value was 93% (95% CI 68 to 99.8), and negative predictive value was 100% (95% CI 83 to 100). For MSCT arthrography, the sensitivity was 92% (95% CI 64 to 99.8), specificity was 96% (95% CI 78 to 99.9), positive predictive value was 92% (95% CI 64 to 99.8), and negative predictive value was 96% (95% CI 78 to 99.9). For conventional arthrography, the sensitivity was comparably high: 96% (95% CI 81 to 99.9). Specificity was (81% [95% CI 67 to 92]); the positive predictive value was 77% (95% CI 59 to 89) and negative predictive value was 97% (95% CI 86 to 99.9). Estimated mean (range) radiation skin doses were reported in a descriptive fashion and were 12.9 mSv (4.5 to 24.9) for conventional arthrography, and 3.2 mSv (2.0 to 4.8) for CBCT arthrography. Estimated radiation skin doses were 0.2 mSv and 12 mSv for MSCT arthrography, depending on the protocol. CONCLUSION: Flat-panel CBCT arthrography can be recommended as an accurate technique to diagnose scapholunate ligament injuries after wrist trauma. Estimated skin doses are low for CBCT arthrography and adapted MSCT arthrography protocols. LEVEL OF EVIDENCE: Level III, diagnostic study.


Asunto(s)
Artrografía , Tomografía Computarizada de Haz Cónico , Ligamentos Articulares/diagnóstico por imagen , Tomografía Computarizada Multidetector , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto , Artrografía/efectos adversos , Artroscopía , Tomografía Computarizada de Haz Cónico/efectos adversos , Femenino , Humanos , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/efectos adversos , Valor Predictivo de las Pruebas , Dosis de Radiación , Exposición a la Radiación/efectos adversos , Reproducibilidad de los Resultados , Piel/efectos de la radiación , Traumatismos de la Muñeca/cirugía
3.
Arthroscopy ; 36(10): 2580-2582, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32442706

RESUMEN

Posterior glenohumeral instability can manifest as posterior shoulder pain and dysfunction, particularly among athletes. Repetitive, posteriorly-directed axial loads, as commonly encountered by contact athletes (American football linemen, rugby players), result in microtrauma that can induce posteroinferior labral tears. Alternatively, SLAP tears commonly seen in throwing athletes may propagate in a posteroinferior direction (i.e., a type VIII SLAP tear), owing to a complex pathologic cascade involving glenohumeral capsular contracture and imbalances among the dynamic stabilizing muscles of both the glenohumeral joint and shoulder girdle. The diagnosis of posterior glenohumeral instability is elucidated by a thorough history and physical examination. Posterior shoulder pain is oftentimes insidious in onset. The throwing athlete with posterior glenohumeral instability may complain of diminished control, accuracy, and generalized shoulder discomfort. A number of provocative physical examination maneuvers have been described (Kim test, Jerk test), which load the humeral head against the labral lesion and recreate patients' symptoms. Magnetic resonance imaging and magnetic resonance arthrography can be of value in demonstrating avulsions of the labrum from the posteroinferior glenoid, and computed tomography is useful for quantifying the location and amount of attritional glenoid bone loss, although in contradistinction to anterior glenohumeral instability, clearly defined thresholds that would otherwise guide treatment have not been established. In the absence of substantial bone loss, arthroscopic posterior capsulolabral repair remains the gold standard for the surgical management of symptoms refractory to nonoperative treatment, and excellent clinical outcomes have generally been reported. However, high rates of return to play at the previous level of participation, particularly among throwing athletes, have been less consistently observed. Risk factors for the need for revision stabilization include surgery on the dominant extremity, female sex, and capsulolabral repairs involving either anchorless techniques or the use of less than 4 anchors.


Asunto(s)
Artroscopía , Inestabilidad de la Articulación/diagnóstico por imagen , Lesiones del Hombro/cirugía , Articulación del Hombro/cirugía , Hombro/cirugía , Artrografía/efectos adversos , Atletas , Femenino , Humanos , Cabeza Humeral/diagnóstico por imagen , Cabeza Humeral/cirugía , Inestabilidad de la Articulación/terapia , Imagen por Resonancia Magnética , Masculino , Factores de Riesgo , Escápula/cirugía , Hombro/diagnóstico por imagen , Articulación del Hombro/diagnóstico por imagen
4.
Radiologe ; 60(3): 273-284, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32067106

RESUMEN

Magnetic resonance (MR) arthrography is a sensitive examination technique. In this institute the majority of MR arthrography examinations are carried out on the shoulder (57 %), followed by hand (24 %) and hip joints (16 %). The use of MR arthrography is superior to native MR imaging (MRI) particularly for detection of partial thickness tendon tears of the shoulder joint. Nevertheless, this technique is invasive, time-consuming and may be uncomfortable for patients. This article summarizes the indications, risks and contraindications of MR arthrography, highlights the puncture technique and illustrates possible pitfalls.


Asunto(s)
Artrografía/métodos , Articulaciones/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Artrografía/efectos adversos , Humanos , Imagen por Resonancia Magnética/efectos adversos , Articulación del Hombro/diagnóstico por imagen
5.
JBJS Case Connect ; 9(1): e9, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30762594

RESUMEN

CASE: We report 2 cases of infants with developmental dysplasia of the hip who underwent arthrography of the hip with use of air for structure identification, which resulted in a presumed air embolism and deep oxygen desaturation. This led to the hypothesis that there is an increased potential of air embolism in the pediatric population given the vascular anatomy of the hip. CONCLUSION: These 2 cases document the important and not well-known complication of air embolism during air arthrography, which resulted in a change of practice for the authors. We strongly recommend against the use of air as an adjunct to routine arthrography in children.


Asunto(s)
Artrografía , Embolia Aérea/etiología , Articulación de la Cadera/diagnóstico por imagen , Artrografía/efectos adversos , Artrografía/métodos , Femenino , Luxación Congénita de la Cadera/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Masculino , Oxígeno/sangre
6.
J Craniofac Surg ; 29(7): e665-e667, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30052611

RESUMEN

The authors here report a rare fatal complication of temporomandibular joint (TMJ) arthrography. A 57-year-old woman suddenly exhibited spasm and dizziness during TMJ arthrography. A multislice CT scanning of head demonstrated a defect in the roof of the glenoid fossa and unanticipated introduction of meglumine diatrizoate into the middle cranial fossa, which should account for neurotoxic symptoms of the patient and could be fatal if not appropriately treated in time. As TMJ puncture is widely performed in clinical practice and generally considered a safe technique, this case might serve as a reminder of the potential risk of the anatomical variation-a defect in the roof of the glenoid fossa-to TMJ clinical practitioners.


Asunto(s)
Artrografía/efectos adversos , Medios de Contraste/efectos adversos , Fosa Craneal Media/anomalías , Diatrizoato de Meglumina/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/complicaciones , Articulación Temporomandibular/diagnóstico por imagen , Medios de Contraste/administración & dosificación , Diatrizoato de Meglumina/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad
7.
Acad Radiol ; 25(12): 1603-1608, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29724673

RESUMEN

RATIONALE AND OBJECTIVES: The objective of this study was to investigate predictors of pain associated with computed tomographic arthrography of the shoulder. MATERIALS AND METHODS: Before shoulder arthrography, all participants were assessed with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life Short Version Instrument (WHOQOL-BREF). The participants were nonrandomized into two groups: the anesthesia group, who underwent prior local infiltration anesthesia before shoulder arthrography, and the nonanesthesia group, who did not undergo prior local infiltration anesthesia. The pain levels at intraprocedure, at 1, 2, 6, and 12 hours, and at 1 and 2 days after injection were assessed by using a visual analog scale. Univariate and multivariate generalized linear model analyses were conducted. RESULTS: Sixty participants in the anesthesia group and 60 participants in the nonanesthesia group were included. The pain level at intraprocedure (3.37 ± 1.94 in the anesthesia group and 3.20 ± 1.34 in the nonanesthesia group) was the highest of the whole pain course. The psychological domain (P = .0013) of WHOQOL-BREF, gender (P = .042), body mass index (P = .0001), and the total number of reinsertion and redirection of needle (P< .0001) were independent predictors of arthrography-related pain. CONCLUSIONS: The pain associated with shoulder computed tomographic arthrography depends on the psychological domain of WHOQOL-BREF, gender, body mass index, and the total number of reinsertion and redirection of needle.


Asunto(s)
Anestesia Local , Artrografía/efectos adversos , Dolor Asociado a Procedimientos Médicos/etiología , Articulación del Hombro/diagnóstico por imagen , Tomografía Computarizada por Rayos X/efectos adversos , Adolescente , Adulto , Artrografía/métodos , Índice de Masa Corporal , Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Femenino , Humanos , Inyecciones Intraarticulares/efectos adversos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Factores Sexuales , Adulto Joven
8.
Br J Radiol ; 90(1078): 20170345, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28749175

RESUMEN

OBJECTIVE: To compare contrast leakage, pain score, image quality and diagnostic performance at different doses and levels of local anaesthesia for direct shoulder magnetic resonance arthrography. METHODS: Patients (n = 157) were prospectively enrolled and allocated to Group 1 (no local anaesthetic), Group 2 (local anaesthesia to subcutaneous fat level; lidocaine 1-2 ml), Group 3 (to deltoid muscle level; 3-5 ml), or Group 4 (to subscapularis muscle level; 6-8 ml). We evaluated the frequency of contrast leakage, periprocedural/postprocedural pain, contrast-to-noise ratio of the intra-articular signal, and subjective image noise/image sharpness. Radiological diagnoses of superior anterior-to-posterior (SLAP) and Bankart lesions were assessed. All data were analysed by one-way analysis of variance/Kruskal-Wall, Χ2/Fisher's exact and DeLong's tests. RESULTS: The frequency of contrast leakage from the injection path and subjective image noise were significantly lower in Groups 1 and 2 than in Groups 3 and 4 (p = 0.001-0.04). Periprocedural/postprocedural pain scores among Groups 2-4 were similar and lower than those of Group 1. The contrast-to-noise ratio (p = 0.11-0.97) and image sharpness (p = 0.12-0.43) were similar among Groups 2-4 and significantly lower than those of Group 1 (p = 0.001-0.02). The diagnostic performance for the assessment of superior anterior-to-posterior and Bankart lesions was better in Groups 2-4 than in Group 1, although there were no significant differences (p = 0.23-0.99). CONCLUSION: Local anaesthesia with 1-2 ml lidocaine at subcutaneous fat level reduced pain and provided optimal image quality in direct shoulder magnetic resonance arthrography. Advances in knowledge: This method can increase image quality, reduce periprocedural/postprocedural pain and potentially reduce the need for re-examination.


Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Artrografía/efectos adversos , Artrografía/métodos , Lesiones de Bankart/diagnóstico por imagen , Lidocaína/administración & dosificación , Imagen por Resonancia Magnética/efectos adversos , Dolor/etiología , Dolor/prevención & control , Lesiones del Hombro , Articulación del Hombro/diagnóstico por imagen , Adulto , Femenino , Humanos , Masculino , Dimensión del Dolor , Estudios Prospectivos , Adulto Joven
9.
Skeletal Radiol ; 46(7): 925-933, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28365852

RESUMEN

OBJECTIVE: To compare three approaches via the anterior and posterior glenohumeral joints, and the rotator interval in fluoroscopy-guided shoulder arthrography according to the experience of the practitioners. MATERIALS AND METHODS: This prospective randomized study was originally designed to have 34 subjects for each approach, and finally evaluated 98 patients (mean age: 51.5 years; 55 men) from July to December 2014, who had shoulder arthrography via the anterior (n = 41) or posterior glenohumeral joint (n = 27) approaches, or via the rotator interval approach (n = 30) by residents (n=76) or fellows (n=22). The success rate, number of punctures, fluoroscopy time, radiation dose, and complications of the three methods were compared, and according to the practitioners. RESULTS: The success rate was 100% for the anterior glenohumeral joint approach (34 out of 34), 90.0% for the posterior glenohumeral joint approach (23 out of 30), and 88.2% for the rotator interval approach (30 out of 34; p = 0.013). There was no difference in the success rate according to the practitioners' experience. Fluoroscopy time was longest for the posterior glenohumeral joint approach (mean: 95.44 s) and shortest for the rotator interval approach (mean: 31.57 s, p = 0.006). Radiation dose was larger by 1st- or 2nd-year residents (p = 0.014), with no difference among the three approaches. Only one patient who underwent arthrography using the posterior glenohumeral joint approach complained about post-procedural pain. CONCLUSION: Fluoroscopy-guided shoulder arthrography via the posterior glenohumeral joint or rotator interval approach may be difficult for trainees, and the posterior glenohumeral joint approach may need a long fluoroscopy time.


Asunto(s)
Artrografía/métodos , Articulación del Hombro/diagnóstico por imagen , Artrografía/efectos adversos , Femenino , Fluoroscopía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Punciones/estadística & datos numéricos , Dosis de Radiación
10.
Skeletal Radiol ; 44(5): 619-27, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25433718

RESUMEN

This review compiles the current literature on the bleeding risks in common musculoskeletal interventional procedures and attempts to provide guidance for practicing radiologists in making decisions regarding the periprocedural management of patients on antithrombotic therapy. The practitioner must weigh the risk of bleeding if therapy is continued against the possibility a thromboembolic occurring if anticoagulation therapy is withheld or reversed. Unfortunately, there is little empirical data to guide evidence-based decisions for many musculoskeletal interventions. However, a review of the literature shows that for low-risk procedures, such as arthrograms/arthrocenteses or muscle/tendon sheath injections, bleeding risks are sufficiently small that anticoagulants and antiplatelet therapies need not be withheld. Additionally, relatively higher-risk procedures, such as needle biopsies of bone and soft tissue, may be safely performed without holding antithrombotic therapy, provided pre-procedural INR is within therapeutic range. Thus, while a patient's particular clinical circumstances should dictate optimal individualized management, anticoagulation alone is not a general contraindication to most interventional musculoskeletal radiology procedures.


Asunto(s)
Artrografía/efectos adversos , Fibrinolíticos/efectos adversos , Hemorragia/etiología , Hemorragia/prevención & control , Radiografía Intervencional/efectos adversos , Humanos , Factores de Riesgo
11.
AJR Am J Roentgenol ; 203(5): 1059-62, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25341145

RESUMEN

OBJECTIVE: The purpose of this study was to prospectively evaluate the effect of benzyl alcohol, a common preservative in normal saline, on postprocedural pain after intraarticular injection for direct shoulder MR arthrography. SUBJECTS AND METHODS: From April 2011 through January 2013, 138 patients underwent direct shoulder MR arthrography. Using the Wong-Baker Faces Pain Scale, patients were asked to report their shoulder pain level immediately before and immediately after the procedure and then were contacted by telephone 6, 24, and 48 hours after the procedure. Fourteen patients did not receive the prescribed amount of contrast agent for diagnostic reasons or did not complete follow-up. Sixty-two patients received an intraarticular solution including preservative-free normal saline (control group) and 62 patients received an intraarticular solution including normal saline with 0.9% benzyl alcohol as a contrast diluent (test group). Patients were randomized as to which intraarticular diluent they received. Fluoroscopic and MR images were reviewed for extracapsular contrast agent administration or extravasation, full-thickness rotator cuff tears, and adhesive capsulitis. The effect of preservative versus control on pain level was estimated with multiple regression, which included time after procedure as the covariate and accounted for repeated measures over patients. RESULTS: Pain scale scores were significantly (p = 0.0382) higher (0.79 units; 95% CI, 0.034-1.154) with benzyl alcohol preservative compared with control (saline). In both study arms, the pain scale scores decreased slightly after the procedure, increased by roughly 1 unit over baseline for the test group and 0.3 unit over baseline for the control group by 6 hours after the procedure, were 0.50 unit over baseline for the test group and 0.12 unit over baseline for the control group at 24 hours, then fell to be slightly greater than baseline at 48 hours with benzyl alcohol and slightly less than baseline without benzyl alcohol. These trends over time were highly significant (p < 0.0001). CONCLUSION: Shoulder arthrography is often associated with postprocedural discomfort that begins immediately after the procedure and resolves by 48 hours. There is significantly increased patient discomfort at 6 and 48 hours when using normal saline preserved with benzyl alcohol as a diluent compared with using normal saline without preservative as a diluent.


Asunto(s)
Artrografía/efectos adversos , Alcohol Bencilo/efectos adversos , Excipientes/efectos adversos , Dolor Postoperatorio/inducido químicamente , Cloruro de Sodio/efectos adversos , Adolescente , Adulto , Alcohol Bencilo/administración & dosificación , Medios de Contraste/administración & dosificación , Medios de Contraste/efectos adversos , Medios de Contraste/química , Excipientes/química , Femenino , Humanos , Inyecciones Intraarticulares/efectos adversos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Dolor Postoperatorio/diagnóstico , Conservadores Farmacéuticos/efectos adversos , Conservadores Farmacéuticos/química , Cloruro de Sodio/administración & dosificación , Resultado del Tratamiento , Adulto Joven
12.
J Pediatr Orthop ; 34(4): 411-4, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24248590

RESUMEN

BACKGROUND: Various pediatric conditions often necessitate a morphologic examination of the hip joint in infancy or childhood, and multiple imaging options have been employed to achieve this goal. Arthrography is one such modality. Different types of contrast media have been utilized and include pharmacologic contrast agents, air, and carbon dioxide. There are scattered reports of complications related to the typical various media used during arthrography. Some of the most concerning are related to gas emboli following the use of air or carbon dioxide. This study assesses the potential complications of carbon dioxide hip arthrography in a series of children over a 12-year period. METHODS: A retrospective review of the medical records of children between the ages of 0 and 3 years who underwent hip arthrography using carbon dioxide gas as the contrast medium was conducted. Outcome measures analyzed included volume of CO2 injected, vital signs, and perioperative and postoperative end-tidal CO2. RESULTS: Our study population was comprised of 118 hips in 90 children. We found no correlation between the volume of CO2 injected and the patient's vital signs or end-tidal CO2 at any point during the perioperative or postoperative period. None of the children exhibited any evidence for cardiopulmonary compromise or clinical signs of embolism. DISCUSSION: To our knowledge, there have been no large studies reporting on carbon dioxide arthrography and its potential complications. There were no gas embolisms and/or cardiopulmonary complications in our patients in the perioperative, postoperative, or 1-year follow-up period. Utilizing carbon dioxide gas as the contrast media for hip arthrography in children is safe and can help aid in the treatment of pediatric hip conditions. LEVEL OF EVIDENCE: Therapeutic Level IV.


Asunto(s)
Artrografía/métodos , Dióxido de Carbono , Luxación Congénita de la Cadera/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Artrografía/efectos adversos , Artrografía/normas , Dióxido de Carbono/efectos adversos , Preescolar , Medios de Contraste , Embolia Aérea/etiología , Femenino , Estudios de Seguimiento , Luxación Congénita de la Cadera/cirugía , Humanos , Lactante , Recién Nacido , Complicaciones Intraoperatorias/etiología , Masculino , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Reproducibilidad de los Resultados , Estudios Retrospectivos
13.
Infect Control Hosp Epidemiol ; 34(11): 1215-7, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24113609

RESUMEN

An outbreak of methicillin-susceptible Staphylococcus aureus joint infections occurred at an outpatient radiology center. We identified 7 case patients; all had undergone magnetic resonance arthrograms with intra-articular joint injections. The outbreak was likely due to unsafe injection practices in preparation of contrast solution for intra-articular injection.


Asunto(s)
Medios de Contraste/efectos adversos , Brotes de Enfermedades , Artropatías/epidemiología , Imagen por Resonancia Magnética/efectos adversos , Infecciones Estafilocócicas/epidemiología , Adulto , Instituciones de Atención Ambulatoria , Artrografía/efectos adversos , Medios de Contraste/administración & dosificación , Femenino , Humanos , Inyecciones Intraarticulares , Artropatías/microbiología , Masculino , Persona de Mediana Edad , Staphylococcus aureus
14.
Eur J Radiol ; 82(7): 1126-34, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-22264694

RESUMEN

Radiologic evaluation of musculoskeletal abnormalities in children is now usually performed by ultrasound and magnetic resonance imaging, owing to their excellent anatomic detail and lack of ionizing radiation. There remains a group of certain congenital and acquired conditions in which computed tomography (CT) can deliver invaluable information, and thus its application is justified in some pediatric patients. This article provides an overview of the most current imaging techniques for the latest generation of CTs, with particular emphasis on dose reduction. We also discuss the most important pathologic entities in which CT significantly contributes to the diagnostic workup or post-therapy follow-up.


Asunto(s)
Artrografía/tendencias , Huesos/diagnóstico por imagen , Enfermedades Musculoesqueléticas/diagnóstico por imagen , Traumatismos por Radiación/prevención & control , Protección Radiológica/métodos , Tomografía Computarizada por Rayos X/tendencias , Artrografía/efectos adversos , Niño , Humanos , Traumatismos por Radiación/etiología , Tomografía Computarizada por Rayos X/efectos adversos
15.
Eur J Radiol ; 81(9): e957-61, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22795238

RESUMEN

PURPOSE: To evaluate the influence of shorter- and longer-acting intra-articular anaesthetics on post-arthrographic pain. MATERIALS AND METHODS: 154 consecutive patients investigated by MR or CT arthrographies were randomly assigned to one of the following groups: 1--intra-articular contrast injection only; 2--lidocain 1% adjunction; or 3--bupivacain 0.25% adjunction. Pain was assessed before injection, at 15 min, 4 h, 1 day and 1 week after injection by visual analogue scale (VAS). RESULTS: At 15 min, early mean pain score increased by 0.96, 0.24 and 0 in groups 1, 2 and 3, respectively. Differences between groups 1 & 3 and 1 & 2 were statistically significant (p=0.003 and 0.03, respectively), but not between groups 2 & 3 (p=0.54). Delayed mean pain score increase was maximal at 4 h, reaching 1.60, 1.22 and 0.29 in groups 1, 2 and 3, respectively. Differences between groups 1 & 2 and 2 & 3 were statistically significant (p=0.002 and 0.02, respectively), but not between groups 1 & 2 (p=0.46). At 24 h and 1 week, the interaction of local anaesthetics with increase in pain score was no longer significant. Results were independent of age, gender and baseline VAS. CONCLUSION: Intra-articular anaesthesia may significantly reduce post-arthrographic pain. Bupivacain seems to be more effective than lidocain to reduce both early and delayed pain.


Asunto(s)
Artralgia/etiología , Artralgia/prevención & control , Artrografía/efectos adversos , Bupivacaína/administración & dosificación , Lidocaína/administración & dosificación , Imagen por Resonancia Magnética/efectos adversos , Tomografía Computarizada por Rayos X/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/administración & dosificación , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
16.
Am J Orthop (Belle Mead NJ) ; 41(6): 277-8, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22837992

RESUMEN

A 65-year-old patient presented with right shoulder pain that had increased in severity over the preceding 2 days. The pain began after the patient had a gadolinium arthrogram for magnetic resonance imaging for rotator cuff evaluation. Examination and laboratory test findings were consistent with a septic glenohumeral joint and emergent arthroscopic irrigation and debridement were performed. Streptococcus sanguinis was isolated from the intraoperative culture, and the infection resolved after a course of antibiotics.


Asunto(s)
Artrografía/efectos adversos , Sepsis/cirugía , Articulación del Hombro/cirugía , Dolor de Hombro/cirugía , Anciano , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Humanos , Sepsis/tratamiento farmacológico , Sepsis/etiología , Articulación del Hombro/patología , Dolor de Hombro/tratamiento farmacológico , Dolor de Hombro/etiología , Streptococcus sanguis/aislamiento & purificación , Resultado del Tratamiento
18.
Acta Neurochir (Wien) ; 154(6): 1033-6, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22527571

RESUMEN

Discography is used as an aid in the diagnosis of back pain related to intervertebral disc pathology. It involves attempting to elicit the patient's pain symptoms by injecting contrast into the suspected pathological disc. The overall complication rate of discography is low, with discitis being the most common complication and acute disc herniation post lumbar discography being reported in a small number of cases. We describe the case of a patient who developed cauda equina compression post lumbar discography.


Asunto(s)
Artrografía/efectos adversos , Desplazamiento del Disco Intervertebral/etiología , Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Polirradiculopatía/etiología , Espondilosis/diagnóstico por imagen , Adulto , Artrografía/métodos , Femenino , Humanos , Disco Intervertebral/patología , Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/patología , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Polirradiculopatía/patología , Polirradiculopatía/fisiopatología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Espondilosis/patología , Espondilosis/fisiopatología
19.
Spine J ; 12(4): 329-35, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22424848

RESUMEN

BACKGROUND CONTEXT: Carragee et al. have recently shown that modern discography injections are associated with subsequent acceleration of disc degeneration, herniation, and loss of disc height. Although needle puncture and pressurization are known trauma events that can create disc degeneration in animal models, another likely culprit in clinical discography-associated degeneration is a direct effect of the contrast agent itself on disc cells. PURPOSE: To test the hypothesis that discography contrast solution would have a deleterious effect on human annulus cells in vitro. STUDY DESIGN: An in vitro study using cultured human annulus cells to assay cell death, cell proliferation, and apoptosis. PATIENT SAMPLE: Annulus cells from eight surgical disc specimens were evaluated (two Thompson Grade III discs and six Grade IV discs) for cell death and proliferation, and an additional five cultures were tested for apoptosis. OUTCOME MEASURES: The proportion of dead and live cells, cell proliferation, and the proportion of apoptotic cells in control and experimental groups. METHODS: After internal review board approval, experimental design used two sets of controls: untreated cells under our normal culture conditions (control) and a set with added glucose to adjust the osmolality to match respective Isovue radiocontrast solution treatments (glucose controls) using a freezing point osmometer. Treated cells received Isovue 200 (iopamidol, Isovue-M 200; Bracco Diagnostics, Inc., Princeton, NJ, USA) at 12.5, 25, 50, or 100 mg/mL. Twenty thousand cells/well were seeded in triplicate in 24 well plates, control or test media added, and incubated for 24 hours. At termination, dead cells were identified with trypan blue staining and percentage dead cells determined. Cells were also tested to determine the percentage of apoptotic cells after 50 or 100 mg/mL Isovue exposures. Proliferation assays used standard plate reader methods. Statistical analysis used repeated measures analysis of variance with SAS software (version 9.2; SAS Institute, Inc., Cary, NC, USA). RESULTS: Analysis of cell death showed a significant increase in the percentage of dead cells with increasing Isovue concentrations compared with control cells (p=.018-.0008). Cell proliferation analyses showed significantly reduced division in Isovue-treated cells (p=.004), and apoptosis assays revealed a significantly higher proportion of apoptotic cells in cells exposed to 50 and 100 mg/mL Isovue (p=.016 and .0003, respectively). CONCLUSIONS: Discography is used extensively in the evaluation of low back pain. Because the lifetime prevalence of disc degeneration and low back pain is high (80% in the general population), many patients may undergo this procedure. Data presented here show that cells exposed in vitro to a radiocontrast agent with adjustments for osmolality have significantly reduced proliferation, increased cell death, and increased programmed cell death (apoptosis). In light of the well-recognized age- and degeneration-related decrease in disc cell numbers, it is possible that radiocontrast exposure may be contributing significantly to disc cell loss with subsequent progression of disc degeneration. Findings presented here provide a plausible cell-based explanation for the previously reported disc degeneration in patients receiving discography contrast solutions.


Asunto(s)
Apoptosis/efectos de los fármacos , Artrografía/efectos adversos , Medios de Contraste/efectos adversos , Disco Intervertebral/patología , Yopamidol/efectos adversos , Adulto , Artrografía/métodos , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Disco Intervertebral/efectos de los fármacos , Vértebras Lumbares/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sacro/patología , Adulto Joven
20.
Curr Pain Headache Rep ; 16(1): 26-34, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22147277

RESUMEN

The diagnosis and treatment of discogenic back pain is challenging. Provocation discography, an invasive spinal procedure, has been suggested as a diagnostic test for internal disc disruption to provide information on disc morphology and reproduction of symptoms. Current applications consist of the evaluation of persistent spinal pain in individuals, including postoperative patients, as well as providing a guide for patient selection for spinal fusion surgery and minimally invasive interventional pain procedures. While the validity of discography has been questioned by multiple scientific studies, technical refinements have addressed many of the initial limitations. An updated review on the safety and utility of discography will be provided, covering key areas of debate including false-positive rates, technical parameters, clinical utility, and risk of discography procedural-related intervertebral disc damage.


Asunto(s)
Artrografía/métodos , Inyecciones Intraarticulares/métodos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Disco Intervertebral/diagnóstico por imagen , Dolor de la Región Lumbar/diagnóstico por imagen , Artrografía/efectos adversos , Reacciones Falso Positivas , Humanos , Inyecciones Intraarticulares/efectos adversos , Desplazamiento del Disco Intervertebral/complicaciones , Dolor de la Región Lumbar/etiología , Dimensión del Dolor , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
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