Transient osteoporosis of the Hip: a densitometric study

Summary Three new cases of transient osteoporosis of the hip are reported. Diagnosis was achieved by plain radiographs, bone scintiscan, magnetic resonance imaging and X-ray absorptiometry of proximal femurs. The densitometry showed at the Ward's triangle a mean reduction of bone mineral density in the affected side of 36%. All subjects were treated with i.v. clodronate for ten consecutive days with a complete recovery of femoral density within 4 months. X-ray absorptiometry allows a quantification of the demineralization process and can be useful in the long term evaluation of this entity.     

Ultrasound transmission velocity of the proximal phalanxes of the non-dominant hand in the study of osteoporosis

Summary The aim of our study was to evaluate a quantitative ultrasound technique for measuring bone tissue at the proximal phalanxes of the non-dominant hand. We correlated the mean value of the amplitude-dependent speed of sound (AD-SoS) measured at the distal metaphysis of the last four proximal phalanxes with age, months since menopause and bone mineral density (BMD) of the lumbar spine in 264 women. We further assessed the ability of the AD-SoS to discriminate between normal and osteoporotic subjects with documented vertebral fractures. We found a positive correlation between the AD-SoS and the lumbar spine BMD, where-as the AD-SoS negatively correlated with age and months since menopause. The AD-SoS showed a higher correlation with age changes and months since menopause than BMD. The AD-SoS was significantly higher in healthy females than in osteoporotic ones (p<0.001). Multiple logistic regression analysis showed for age-adjusted values that AD-SoS decrease is significantly associated to the presence of fracture. Our results suggest that AD-SoS is valuable in assessing age and menopause related bone loss and is useful for diagnosing osteoporosis.     

Dual photon absorptiometry of lumbar spine in West European (Belgian) postmenopausal females: normal range and fracture threshold

Summary Bone mineral content (BMC) and bone mineral density (BMD) of lumbar spine have been measured in 695 healthy postmenopausal and 64 type I osteoporotic Belgian, Caucasian females. Bone loss is strongly correlated to time elapse from menopause (Tm) with a maximum rate of bone loss during the first five years of menopause. BMC (gHA)=41.6+0.662 ln Tm –0.481 (ln Tm)² and BMD (gHA/cm²)=0.91+0.00711 in Tm –0.00846 (ln Tm)² (in both cases p<0.001 and Tm expressed in months of menopause). After 20 years of menopause, 50 to 60% of normal women have vertebral BMC and BMD values below the 90th percentile of women with vertebral fractures and, thus, might be considered to have asymptomatic osteoporosis. We conclude that prevention of postmenopausal osteoporosis should be initiated as soon as possible after the onset of menopause and that bone density screening should be extended in elderly in order to detect and allow treatment of asymptomatic densitometric osteoporosis.     

Does a single local absorptiometric bone measurement indicate the overall skeletal status? Implications for osteoporosis and osteoarthritis of the hip

Summary Regional bone mineral content (BMC) and density (BMD) (head, arms, chest, spine, pelvis, legs) of a total body dual photon¹⁵³Gd absorptiometry (DPA) scan were measured in 20 healthy postmenopausal women, 27 postmenopausal women with hip fracture, and 17 postmenopausal women with osteoarthritis of the hip. In addition, local BMC and BMD were measured in the proximal and distal regions of the distal forearm (BMC_prox, BMD_prox, BMC_dis, BMD_dist) by single photon absorptiometry (SPA); and in the lumbar spine (BMC_L2-L4 and BMD_L2-L4) by¹⁵³Gd DPA. The overall impression was a reduction of bone mass in hip fracture patients compared with healthy controls and an increase in the bone mass of osteoarthritic patients. These results were valid using both regional values of the total body scan, and local forearm and lumbar spine measurements, and statistically significant using one-way analysis of variance. There were, however, also significant within-group between-region differences (one-way analysis of variance), showing that the bone mass of the pelvis and legs in hip fracture patients was more reduced than in the remaining skeleton; in osteoarthritic patients it was not increased but rather unchanged or slightly reduced. The differences between the level of the three local measurements (BMD_prox BMD_dist BMD_L2-L4), on the one hand, and the level of the six regional BMD values, on the other hand, were investigated by the two-way analysis of variance: local measurements = rows; regional values = columns. This analysis showed that none of the three local measurements was statistically better than the other two in predicting the overall level of skeletal bone mass as judged by the six regional values. We conclude that serious osteoporotic bone loss has a generalized nature, however, with a tendency towards lower values in the regions affected by fracture (viz: low bone mass in the legs of femoral neck fracture patients). Osteoarthritis may be associated with a high bone mass in most areas, but low values in the affected regions. Local lumbar spine measurement of bone mass by DPA is not superior to local forearm measurement of bone mass by SPA in predicting the nature of overall osteoporotic or osteoarthritic bone change.     

Prevalence of sarcopenia and its association with osteoporosis in 313 older women following a hip fracture

Changes in body composition, including a decrease in muscle and bone mass, accompany aging. Our aim was to assess the prevalence of sarcopenia and its association with osteoporosis in hip-fracture women. We performed a Dual-Energy X-Ray Absorptiometry (DXA) scan in 313 of 340 women, 20.9 ± 6.5 (mean ± S.D.) days after hip-fracture occurrence. To adjust appendicular lean mass for body size we divided it by height squared in each woman. A total of 180 of the 313 women (58%) were sarcopenic, whereas 230 (74%) were osteoporotic. After adjustment for age and interval between fracture and DXA scan we found a significant association between sarcopenia and osteoporosis (p = 0.026). For a sarcopenic woman the adjusted odds ratio (OR) for osteoporosis was 1.80 (95%CI = 1.07-3.02). Our data shows the high prevalence of sarcopenia and its significant association with osteoporosis in a large sample of hip-fracture women. Data supports a research approach on preventive and treatment strategies for osteoporosis and sarcopenia targeting both bone and muscle tissue. Furthermore, data should be considered when the economic burden of sarcopenia is estimated, given the high proportion of sarcopenic women with bone fragility.     

超声辅助尿激酶溶栓的体外实验研究

目的 :评价体外治疗性超声 ( ETUS)辅助尿激酶 ( UK)溶栓的效果 ,比较连续波超声与脉冲波超声助溶作用的差异。方法 :抽取 16名健康自愿者静脉血各 5 ml,以 1ml/份加入试管内于37℃水中孵育 2 h共制成 80个血凝块。分为五组行不同溶栓处理 :1对照组 ;2单纯超声组 ;3单纯 UK组 ;4脉冲波超声 UK组 ;5连续波超声 UK组。以溶栓率评价溶栓效果。结果 :单用超声组溶栓率与对照组比较无显著性差异 ( P >0 .0 5 )。超声 UK的两组溶栓率均较单用 UK组显著增加 ( P <0 .0 1)。其中 ,连续波超声 UK组溶栓率又高于脉冲波超声 UK组 ( P <0 .0 1)。结论 :ETUS不能直接溶栓 ,但能辅助 UK溶栓 ,且连续波超声助溶作用大于脉冲波超声。     

Correlation of ultrasound imaging of oral swallow with ventilatory alterations in cerebral palsied and normal children: Preliminary observations

Preliminary results of an investigation that synchronizes the videotaped output of a ultrasound camera and the analog data from physiological measurements of swallowing and ventilation in normal and cerebral palsied (CP) children are presented. Four cerebral palsied children and three control children undertook a single sip-swallow of 5 ml of liquid and a solid mastication-swallow sequence on three occasions according to a defined protocol. The CP children exhibited much more variability and less control of the liquid bolus than did the controls. The ultrasound image clearly demonstrates the lack of control of the posterior of the tongue in many CP children. Some parts of the sequence of oral swallow and the time to achieve maximum anterior displacement of the hyoid bone appear to be slowed. The sequential events of swallowing show less variability as the sip-swallow proceeds from the oral voluntary to pharyngeal and lower involuntary phases. This study also identified a short-latency apnea that appears to accompany a saliva (protective) swallow and a long-latency apnea that accompanies semisolid or liquid bolus (alimentary) swallows. Further investigations of normal and CP children utilizing a combined diagnostic imaging-physiological measurement approach will follow this initial study.     

Medical costs of intravascular ultrasound optimization of stent deployment. Results of the multicenter randomized 'REStenosis after Intravascular ultrasound STenting' (RESIST) study

OBJECTIVE: Intravascular ultrasound (IVUS) can be used to optimize the deployment of stents. The aim of this study was to assess the acute and long-term medical costs of the use of IVUS through the results of the 'REStenosis after Intravascular ultrasound STenting' (RESIST) study. METHODS: One hundred and fifty-five patients were randomized to routine stent deployment with ( n = 79) versus without ( n = 76) IVUS guidance, with clinical follow-up over medical costs (hospitalization procedural costs) were calculated using a cost accounting system at the time of stent implantation and for all repeat lesion revascularizations. (At the time of writing the exchange rate was 1 Euro = 1 US dollar.) RESULTS: Because of the cost of IVUS catheters and the need for more balloons, acute procedural costs were 18% higher in the group with IVUS guidance (2934 &#45 670 Euros vs 2481 &#45 911 Euros). Clinical events (death, myocardial infarction, unstable angina or lesion revascular 18 months. The ization) occurred in 28/76 (37%) in the group without IVUS, versus 20/79 (25%) (OR = 1.7; 95%CI = [0.82; 3.63]) in the group with IVUS. There was a higher number of revascularization procedures in the control group (31 in the control group vs 20 in the IVUS group). The cumulative medical costs at 18 months were only slightly higher in the IVUS group (4535 &#45 2020 Euros vs 4679 &#45 1471 Euros in the IVUS group), as the higher acute costs in the group with IVUS guidplus ance were partially offset by the lower cost for revascularization procedures. Sensitivity analysis using variations of the unit costs as well as variations in the number of revascularization procedures and length of hospital stay showed that the overcost remained in a range between 1% and 7.6%. CONCLUSIONS: Over 18 months of followup, despite higher acute costs, IVUS optimization of stent deployment did not considerably increase the medical costs. (Int J Cardiovasc Intervent 2000; 3: 207-213)     

Bone mineral content of the third lumbar vertebra during 18 months of prednisolone treatment for giant cell arteritis

Summary Altogether forty-four patients with giant cell arteritis (GCA) were randomly allocated to either daily morning or alternate-day administration of prednisolone. The BMC of the third lumbar vertebra was determined using dual photon absorptiometry. At least ten measurements were performed in each patient during a period of 18 months. During the course of treatment there was no significant change of the mean BMC in either group compared to the pre-treatment value. The changes of BMC were independent of such potentially explanatory variables as cumulative dose of prednisolone, initial BMC, sex and body weight. Corticosteroid treatment in patients with GCA, in the doses used by us, does not appear to cause excessive bone loss.     

体外治疗性超声对正常心肌的影响

目的 :探讨体外治疗性超声 (ETUS)对正常心肌的影响。方法 :30例健康志愿者 ,随机均分成两组 ,ETUS组和空白对照组 ,ETUS的频率和声强分别为 0 .8MHz和 1.8W cm2 ,观察ETUS前 10min及ETUS后 12～ 2 4h内血清心肌肌钙蛋白I(cTnI)和肌酸磷酸激酶同工酶 (CK MB)水平的变化。结果 :ETUS前后 ,血清cTnI和CK MB水平差异无显著性意义 (P >0 .0 5 )。结论 :安全剂量的ETUS对正常心肌无明显损伤作用。     

超声内镜与B超诊断胰腺疾病的对比分析

目的 探讨超声内镜(EUS)和B超对胰腺疾病的诊断价值。方法 对1999年6月至2001年6月期间123例胰腺疾病患行EUS检查并与体表B超检查结果进行比较。结果 63例胰腺癌、45例胰腺炎和11例其它胰腺疾病患经EUS确诊。38例胰腺癌，28例胰腺炎和5例其它胰腺疾病经US确诊。EUS诊断胰腺疾病的敏感性与准确性均明显高于B超，EUS与B超诊断符合率分别为96．7％(119／123)与56．9％(70／123)(P＜0．01)。结论 EUS在胰腺疾病诊断中有较高的特异性和准确性，与B超联合应用有助于胰腺疾病的诊断。     

一种新型声学造影剂经静脉注射评价正常心肌血流灌注实验研究

目的:评价自行研制的Sigma新一代声学造影剂经周围静脉注射心肌声学显象效果。方法:对10条闭胸犬麻醉后经周围静脉注射Sigma造影剂(1ml/kg)进行心肌声学造影。同时观察其对实验犬心率、血压的影响。结果:注射Sigma造影剂共45次,心肌显影成功率100％,心肌显影强度2级25％(11次)、3级75％(34次)。心肌显影-时间强度曲线,造影前前壁、侧壁、后壁峰值密度(PI)分别为:0.6±0.09、0.7±0.095、0.68±0.07;曲线下面积(AUC)为0.2±0.015、0.22±0.21、0.21±0.02。心肌造影后前壁、侧壁、后壁PI分别为:11.9±1.1、10.9±0.9、10.8±1.0;AUC为13±1.3、11.7±1.05、12.7±1.2,造影前、后PI、AUC差异显著,P<0.01。造影后心率、血压均无影响。结论:Sigma新型声学造影剂具有良好的心肌显象作用,可用于评价心肌血流灌注。     

Impaired compensatory coronary artery enlargement in atherosclerosis contributes to the development of coronary artery stenosis in diabetic patients: An in vivo intravascular ultrasound study

AIMS: Coronary arteries affected by atherosclerosis undergo focalcompensatory enlargement, which can be detected by intracoronaryultrasound but not by angiography. Diabetic patients when comparedwith non-diabetics have a more accelerated progression of coronaryartery disease and a more diffuse narrowing of the coronaryarteries. Intracoronary ultrasound can clarify if this is dueto less compensatory coronary artery enlargement as a responseto atherosclerosis. METHODS AND RESULTS: Ten non-diabetic and 15 diabetic patients with coronary arterydisease, with angiographically determined one- or two-vesseldisease, underwent intracoronary ultrasound examination of thenon-stenotic coronary artery. Forty-five sites with luminalstenosis, detected by intracoronary ultrasound, were analysed(15 in non-diabetics, 30 in diabetics). Vessel and lumen area,atherosclerotic plaque area and plaque composition were evaluated.Vessel area was also measured proximal and distal to the healthysegment. In the diabetic patients, there was less vessel areaincrease from the proximal healthy segment into the atheroscleroticsegment than in the non-diabetic patients (99% separate-varianceconfidence intervals for differences between diabetics' andnon-diabetics' means=0·29 mm², 2·71 mm²). Theproximal plaque free vessel area, the atherosclerotic plaquearea and plaque composition were similar between the two groups. CONCLUSION: Diabetics with atherosclerosis have less compensatory coronaryartery enlargement than non-diabetics. This may explain thediffuse and accelerated course of coronary artery disease inthese patients.     

Adverse reactions to ultrasound contrast agents: is the risk worth the benefit?

The introduction of ultrasound contrast agents has led to a marked improvement in diagnostic capabilities in echocardiography. As no serious adverse events were seen during the preclinical development phase, ultrasound contrast agents were thought to be safe. Recently, three fatal and 19 severe, non-fatal adverse reactions were reported in a post marketing analysis of more than 150,000 studies of Sonovue, which has led to the addition of several contra-indications for the use of this ultrasound contrast agent. Although a strong relationship was established between the non-fatal cases and administration of Sonovue, a causal relationship between the fatal cases and the use of Sonovue is debatable. Therefore, the risk associated with the use of this ultrasound contrast agent should be judged carefully, taking into consideration the prevalence of adverse effects of other contrast media and diagnostic procedures used in cardiology.     

老年2型糖尿病患者骨密度及骨超声改变的观察

目的：探讨老年2型糖尿病患者跟骨定量超声（QUS）和腰椎骨密度（BMD）的改变，方法：采用QUS骨量分析系统检测94例老年2型糖尿病患者和90例健康对照者的跟骨超声传导速度（SOS），超声振幅衰减（BUA）及骨强度指数（STI），用双能X线骨吸收测量仪（DXA）测定前后位腰椎BMD，并同时进行了骨生化指标的检测。结果：2型糖尿病患者BMD（g/cm^2)男性L2为0．863，低于对照组的0．931（P＜0．05）；女性L2，L2－4分别为0．826和0．841，均低于对照组0．903和0．905（P＜0．01）；2型糖尿病患者跟骨BUA（dB/MHz)男，女分别为64．63，51．05，均低于对照组71．38和61．76（P＜0．01），糖尿病组STI男，女分别为83．12％和67．64％，低于对照组91．24％和69．03％（P＜0．05）。糖尿病组女性SOS（m/s)为1487．28低于对照组1502．34（P＜0．05）。结论：老年2型糖尿病患者跟骨BUA、SOS和腰椎前后位BMD均较正常对照组降低，提示有骨量丢失。     

胫骨定量超声测量对老年妇女骨折危险性的评价及其临床意义

目的　探讨胫骨定量超声(QUS)骨量分析系统预测老年妇女骨折危险性的临床实用性以及骨折的阈值。　方法　采用QUS技术检测63例骨折患者(骨折组)和85名社区健康老年妇女志愿者(对照组)的胫骨超声传导速度（SOS）值,并对其变化规律进行分析。　结果　骨折组的SOS值(3712.7m/s)明显低于对照组（3831.4m/s,P＜0.01）,且SOS值与骨折危险性呈负相关,SOS值每下降100m/s,骨折危险性增加约1倍。若以骨折危险性高于20%为骨折高危人群,则骨折的SOS阈值为3850m/s。　结论　胫骨QUS测量对诊断老年妇女骨质疏松症和预测骨折危险性有很大的临床应用潜力。     

Three-dimensional ultrasound imaging for the evaluation of carotid atherosclerosis

Introduction

Emerging data suggests that 3-dimensional (D) ultrasound (US) may provide us with a new tool for the identification of the vulnerable carotid plaque.

Methods

A systematic review of the PubMed, Scopus and Cochrane databases regarding the reproducibility and effectiveness of 3D US in evaluation of carotid plaque disease (CPD) was performed.

Results

Seven studies on the reproducibility of 3D ultrasound evaluation of plaque volume (PV) were identified. All studies reported good intra- and inter-observer reproducibility ranging from 2.8–6.0% to 4.2–7.6%, respectively. In addition, ten studies evaluating 3D carotid plaque progression with and without treatment were retrieved. In the 4 studies where 2D and 3D US features were compared, PV rather than intima media thickness (IMT) was a more sensitive marker of plaque change as a response to treatment. However, there were no studies evaluating changes in plaque morphology or specific composition features post-treatment with both 2 and 3D US. Finally, only one study was identified regarding the 3D composition differences of CPD between symptomatic and asymptomatic patients.

Conclusion

The current evidence supports the good reproducibility of the 3D US on the evaluation of carotid plaque volume, however with high heterogeneity between studies. There is also preliminary evidence that PV measurements may be more sensitive than IMT in the identification of plaque change post-treatment, though, more plaque-related evidence is necessary. Further research is needed to establish if 3D is superior to 2D US in the identification of the vulnerable carotid plaque in clinical settings.     

Non-invasive real-time imaging of atherosclerosis in mice using ultrasound biomicroscopy

There are increasing needs to develop imaging techniques to study in vivo vascular morphology and function in various mouse models of atherosclerosis. Using ultrasound biomicroscopy (UBM), we developed and validated a new imaging protocol to follow lesion progression in atherosclerotic mice. ApoE and LDL receptor double knockout mice (DKO) with various degree of atherosclerosis and normal control mice were imaged at the level of the ascending aorta using UBM. Average plaque thickness, as well as plaque area were delineated in the short-axis images, and were subsequently compared with histological measurements. We showed that plaque area at this vascular site was closely correlated to total plaque burden from en face measurement (p < 0.0001). UBM-measured plaque thickness and area correlated with indices for histology measures from the same vascular region (p < 0.0001 respective p < 0.0001). Furthermore, in 16 DKO mice aged from 32 to 35 weeks, UBM showed significantly weekly increases of IMT in the ascending aorta from 0.106 ± 0.108 mm at 32 weeks of age to 0.256 ± 0.345 mm at 35 weeks of age (p = 0.0002). In conclusion, this novel imaging protocol provides us with a non-invasive, accurate and inexpensive way to follow lesion progression in mice in vivo.     

Bone loss after stroke over 52 weeks at os calcis: influence of sex, mobility and relation to bone density at other sites

BACKGROUND: As life expectancy increases after stroke, skeletal consequences become increasingly important, and patients at risk of fracture require identification. We have investigated peripheral bone mineral density (BMD) measurement at the heel as a possible surrogate for hip dual energy X-ray absorptiometry measurement and we have related bone loss over 52 weeks to balance and mobility. METHODS: BMD at the heel (PIXI), proximal femur and whole body (QDR4500A), Tinetti (a measure of mobility and balance) and Barthel (a measure of activities of daily living) scores were measured in 52 patients (27 males and 25 females) within 8 weeks of stroke and repeated in 27 (15 males and 12 females) after 52 weeks. RESULTS: BMD was not initially low at the femoral neck (FN). A significant fall occurred on the stroke side (SS) over 52 weeks at the heel, FN and total hip (TH), in both sexes, but was greater in women. On the non-SS, women lost bone at the TH and heel. Patients who were in the lowest Tinetti score tertile initially, showed significant loss of bone in the FN (14.5%) and at the heel (12.2%) on the SS. BMD at the SS heel correlated with the FN at 8 weeks (r = 0.64, P<0.01) and at 52 weeks (r = 0.60, P<0.01) after stroke. Women lost more bone than men on SS but also lost bone on the non-SS at the same sites, suggesting that SS bone loss may result from factors additional to stroke. CONCLUSION: Heel BMD was a useful surrogate for hip BMD. Low initial Tinetti scores were an indicator of bone loss and, together with initial BMD measurements, provide a useful indication for those needing early prophylaxis against bone loss.