Ex vivo estimation of thoracolumbar vertebral body compressive strength: The relative contributions of bone densitometry and vertebral morphometry

The estimation of vertebral fracture risk in individuals with suspected osteopenia is commonly based on measurements of lumbar spine bone density. The efficacy of vertebral size and deformity, as assessed by vertebral morphometry, in the prediction of fractures has been less studied. In an ex vivo investigation the regional relationships between vertebral size, vertebral deformity, bone density and compressive strength throughout the thoracolumbar spine were examined. In 16 vertebral columns (T1–L5) the bone mineral content (BMC) and bone mineral density (BMD) of each segment were measured using lateral projection dual-energy X-ray absorptiometry, and the vertebral cancellous density (VCD) and mid-vertebral cross-sectional area (CSA) measured using quantitative computed tomography. Vertebral body heights were determined from mid-sagittal CT scans, and vertical height ratios calculated for each segment. The failure load and failure stress of the isolated vertebral bodies were determined using a material testing device. Separate analyses were performed for the upper (T1–4), middle (T5–8) and lower (T9–12) thoracic, and lumbar (L1–5) segments. In all regions, failure load was strongly correlated with BMD (r=0.82–0.86), moderately correlated with VCD (r=0.60–0.71) and vertebral height (r=0.22–0.49), and poorly correlated with the height ratios (r=0.04–0.33). Failure stress was best predicted by BMD (r=0.73–0.78) and VCD (r=0.70–0.78) but was poorly correlated with all morphometric variables (r=0.01–0.33). The segmental correlations between BMD and VCD ranged fromr=0.49 tor=0.79. For all regions, BMD and VCD were included in the stepwise regression models for predicting failure load and failure stress. Either the mid-vertebral height or CSA were included in all the failure load models, while mid-vertebral height was included in only one of the failure stress models. The results suggest that vertebral deformity and size (as assessed by vertebral morphometry) make only a minor contribution to the prediction of vertebral strength additional to that provided by bone densitometry alone. The consistent regional relationships between variables appear to support the practice of global fracture risk assessment based on lumbar spine densitometry.     

Giant infectious intracavernous carotid artery aneurysm presenting as intractable epistaxis

Infectious intracavernous carotid artery aneurysms usually present with ophthalmoplegia and/or signs of cavernous sinus thrombosis. We report an unusual case in which a patient with AIDS presented with intractable epistaxis secondary to rupture of a giant infectious intra-cavernous carotid artery aneurysm. Culture of the aneurysm grew mycobacterium avium intracellulare (MAI). The patient was treated successfully by excision of the aneurysm and reconstruction of the internal carotid artery with a saphenous vein interposition graft.     

Nutritional status of land-based U.S. Navy divers

The nutritional status of 16 male, land-based U.S. Navy divers was assessed to collect baseline information for a cold water dive series. Diet records, blood samples, and 24-h urine collections were obtained and analyzed. The divers were deriving 17 +/- 1%, 40 +/- 2%, 32 +/- 2% of their calories from protein, carbohydrate, and fat, respectively. The remaining calories were furnished by alcohol (11 +/- 2%), an amount within the American Heart Association's guidelines. Crude fiber intake was low (3.7 +/- 0.4 g/d) whereas cholesterol (507 +/- 101 mg/d) and sodium intakes (4462 +/- 599 mg/d) were high. Mean intakes of vitamin B6 and folacin were below the Military Recommended Dietary Allowances. Mean blood concentrations and urinary excretion of minerals were normal but urinary sodium excretion was high. Results indicate that the divers' intakes of sodium and cholesterol were high, whereas intakes of complex carbohydrate and crude fiber were low. Whether these dietary patterns are suitable for extended dives, especially in cold water, remains to be determined.     

Larynx cancer risk factors

The larynx cancer relative risk has been evaluated (328 cases) in the stationary-native Upper Silesians (63.7%) and migrating (36.3%) male population. The particular control groups (656 men) included 418 and 238 men respectively not suffering from malignant neoplasms. The essentially higher larynx cancer incidence risk has been shown for men manual labor and exposed to the influence of various dusts, gases and vapors and other pollutants in their place of work. The increased substantial incidence risk is also true for men who smoke tobacco and are professionally exposed to the pollution. The results in regard to the consumption of raw and boiled vegetables suggest that these may be inhibitors of the neoplasmatic process in the area of larynx (although not only). The frequency of the consumption of alcohol--vodka or beer--increases the larynx cancer incidence risk both among autochthons and immigrants. Nevertheless, the data concerning the amount of alcohol consumed are less valuable here; they do not allow to establish fully reliable quantitative levels of the beer or vodka consumed. In comparison with the literature of the subject, divergent data have been obtained as far as the joint influence of drinking alcohol with simultaneous smoking of tobacco and professional exposure are concerned.     

C1 esterase inhibitor deficiency in X-linked hypogammaglobulinaemia: an anomaly fostering anaphylactoid reactions following intramuscular gammaglobulin administration

A patient with apparent X-linked agammaglobulinaemia was found to be inordinately susceptible to anaphylactoid reactions to intramuscular injections of gammaglobulin. The patient was found also to have low levels of C1 esterase inhibitor (C1 INH). The possibility that the C1 INH deficiency and in this patient, whether genetic or acquired, fostered the susceptibility to the production of anaphylactoid reactions after gammaglobulin injections urges further studies of the association of C1 INH deficiency and anaphylactoid reactions to gammaglobulin injections. The possibility that C1 INH levels like C1q levels may be low in hypogammaglobulinaemic patients as a consequence of increased catabolism of this regulator of the complement system when IgG levels are low is considered.     

Specific Hemagglutinin and a Modulator of Complement in Cockroach Hemolymph

Natural hemagglutinin activity against vertebrate erythrocytes is present in the hemolymph of the cockroach Blabarus craniifer. The hemagglutinin titer against rabbit erythrocytes is high, whereas sheep and horse red cells agglutinate weakly. Hemagglutinin activity was depressed by the complement inhibitor, cobra venom factor. Cockroach hemagglutinin is heat-labile; all activity is destroyed by heating at 56 C for 1 hr. A humoral factor similar to the complement component 3 proactivator is also present in cockroach hemolymph. The formation of the cobra venom factor-hemolymph "complex" is dependent on the presence of divalent cations and will not proceed at 56 C. The hemolytic intermediate formed after treatment of cockroach hemolymph with cobra venom factor was active in the presence of serum treated with ethylenediaminetetraacetic acid to inactivate the early complement components.     

Interstitial deletions 4q21.1q25 and 4q25q27: Phenotypic variability and relation to Rieger anomaly

We describe clinical and chromosomal findings in two patients with del(4q). Patient 1, with interstitial deletion (4)(q21.1q25), had craniofacial and skeletal anomalies and died at 8 months of hydrocephalus. Patient 2, with interstitial deletion (4)(q25q27), had craniofacial and skeletal anomalies with congenital hypotonia and developmental delay. These patients shared certain manifestations with other del(4q) patients but did not have Rieger anomaly. Clinical variability among patients with interstitial deletions of 4q may be related to variable expression, variable deletion, or imprinting of genes within the 4q region. © 1995 Wiley-Liss, Inc.