1,721,132 research outputs found
Magnetic resonance imaging of the hypothalamus Pituitary unit in children suspected of hypopituitarism: Who, how and when to investigate
No full textThe magnetic resonance (MR) identification of pituitary hyperintensity in the posterior part of the sella has been the most striking recent finding contributing to the diagnosis of “idiopathic” and permanent GH deficiency (GHD). Moreover, advancements in DNA technology have shed new light on the study of the genetic causes of hypopituitarism. Abnormalities in two genes, the GH-N encoding the GH and the GHRH receptor (GHRH-R), have been identified, while mutations in five other gene-encoding transcription factors such as Pit-1, Prop-1, Hesx-1, Lhx-3 and Lhx-4 involved in anterior pituitary development, have also been described. MR imaging shows marked differences in pituitary morphology indicating different GHD etiologies and different prognoses. Ectopic posterior pituitary is a specific marker of permanent GHD. These patients do not have Pit-1, Prop-1, or Lhx-3 mutations and should be carefully monitored for evolving pituitary hormone defects, though they do not require GH re-evaluation in adulthood; selected cases may have Hesx-1 or Lhx-4 mutations. MR evidence of normal or small anterior pituitary gland, enlarged empty sella, pituitary hyperplasia and/or intrasellar or suprasellar mass when associated with combined pituitary hormone deficiency call for molecular analysis of Pit-1, Prop-1, Hesx-1, or Lhx-3. Limitation of neck rotation and Chiari-I malformation may suggest Lhx-3 or Lhx-4 mutations (exceedingly rare). In “idiopathic” isolated GHD, evidence of normal anterior or small anterior pituitary size with normal location of posterior pituitary and normal connection between the hypothalamus and pituitary gland is suggestive of “transitory” or false positive GHD; patients with such characteristics should be re-evaluated well before reaching adult height. In selected cases, anterior pituitary height that is 2 SD below age-adjusted normal pituitary height could be suggestive of GHRH-R gene defect; it is worth pointing out that normal pituitary MR together with severe GHD has been observed, though rarely, in subjects with a genetic origin of GHD
Capsulo-labro-ligamentous lesions of the shoulder: Evaluation with MR arthography [Lesioni del complesso capsulo-labro-legamentoso della spalla: Valutazione con artro-RM]
No full textPurpose. The aim of the study was to analyse the accuracy of MR arthrography in the evaluation of capsulo-labro-ligamentous lesions of the shoulder in patients with glenohumeral joint instability. Materials and methods. From 1999 to 2001 fifty-eight patients with glenohumeral joint instability were studied by MR arthrography. Twenty-seven patients underwent surgical repair: 11 by arthroscopic and 16 by arthrotomic approach. All shoulder evaluations were performed with T1 and T2 weighted axial, coronal and sagittal oblique images, before and after intra-articular injection of gadolinium contrast. Results. Forty capsulo-ligamentous lesions (including 14 capsular ruptures with extravasation of the contrast medium) were detected by MR arthrography. Fifty-two labral tears (36 of the anterior, 13 of the superior and 3 of the posterior glenoid labrum) were identified: 11 out of 52 were not recognized before gadolinium contrast injection. Five rotator cuff tears were identified, one of which was not shown in the pre-injection examination. Surgical results confirmed the MR arthrographic findings in 25/27 patients. In one case MR arthrography did not recognize a SLAP lesion; in another case it identified a tear of the capsule but not of the glenoid labrum. Conclusions. In many cases of subacute glenohumeral joint lesions with intracapsular fluid, MR may accurately evaluate capsulo-labral-ligamentous lesions. Indeed, the examination of lesions is limited by the absence of the natural contrast determined by fluid; in such cases, intraarticular injection of gadolinium contrast is necessary. MR arthrography evaluates the degree of capsulo-labro-ligamentous tears and may guide the surgical approach.Purpose. The aim of the study was to analyse the accuracy of MR arthrography in the evaluation of capsulo-labro-ligamentous lesions of the shoulder in patients with glenohumeral joint instability. Materials and methods. From 1999 to 2001 fifty-eight patients with glenohumeral joint instability were studied by MR arthrography. Twenty-seven patients underwent surgical repair: 11 by arthroscopic and 16 by arthrotomic approach. All shoulder evaluations were performed with T1 and T2 weighted axial, coronal and sagittal oblique images, before and after intra-articular injection of gadolinium contrast. Results. Forty capsulo-ligamentous lesions (including 14 capsular ruptures with extravasation of the contrast medium) were detected by MR arthrography. Fifty-two labral tears (36 of the anterior, 13 of the superior and 3 of the posterior glenoid labrum) were identified: 11 out of 52 were not recognized before gadolinium contrast injection. Five rotator cuff tears were identified, one of which was not shown in the pre-injection examination. Surgical results confirmed the MR arthrographic findings in 25/27 patients. In one case MR arthrography did not recognize a SLAP lesion; in another case it identified a tear of the capsule but not of the glenoid labrum. Conclusions. In many cases of subacute glenohumeral joint lesions with intracapsular fluid, MR may accurately evaluate capsulo-labral-ligamentous lesions. Indeed, the examination of lesions is limited by the absence of the natural contrast determined by fluid; in such cases, intraarticular injection of gadolinium contrast is necessary. MR arthrography evaluates the degree of capsulo-labro-ligamentous tears and may guide the surgical approach
Treatment of unstable osteochondritis dissecans in adults with autogenous osteochondral grafts (Mosaicplasty): Long-term results
No full textPurpose: the unstable osteochondritis dissecans (OCD-type II and III according to the ICRS classification) of the knee largher than > 2.5 cm2 in adults are uncommon lesions and there is no consensus on how to treat them. Medium-term studies have reported good re sults using autogenous osteochondral plugs (mosaicplasty). the aim of this study is to analyze the long-term results of this technique for the treatment of unstable OCD in a selected group of adult patients. Methods: four patients with OCD at either one of the femoral condyles were included in this prospective study. the average age was 21.2 years (range, 18-24 years). the OCD lesions were classified as type II in three patients and type III in one patient and the average size was 3.8 cm2 (range, 2.55-5.1 cm2). The lesions were treated in situ with a variable number of autogenous osteochondral plugs (Ø 4.5 mm2). The Modified Cincinnati, Lysholm II and tegner scores were used for clinical and functional evaluation. Magnetic resonance arthrography (MRA) was performed before surgery and at 2, 5 and 10 years after surgery. A modified MOCART score was used to evaluate MRA findings. Results: the average follow-up duration was ten years and 6 months (range, 10-11 years). no complications occurred. At the final follow-up, all scores (clinical, functional and MOCART) improved. in all but one of the patients MRA showed complete osteochondral repair. Conclusions: the fixation of large and unstable OCD lesions with mosaicplasty may be a good option for treating type ii or III OCD lesions in adults. the advantages of this technique include stable fixation, promotion of blood supply to the base of the OCD fragment, and grafting of autologous cancellous bone that stimulates healing with preservation of the articular surface. Level of evidence: Level IV, therapeutic case series
Trattamento combinato della metatarsalgia non-Morton's-neuroma linked: esperienza preliminare co follow-up a 3 mesi
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