Relationship between 99Tcm-MDP uptake and bone mineral density in patients with prostatic carcinoma

Seventeen men with prostatic carcinoma were investigated with quantitative bone scintigraphy and quantitative computed X-ray tomography before orchiectomy and up to 6 months after this operation. The uptake of 99Tcm-labelled methylene disphosphonate (99Tcm-MDP) and bone mineral density (BMD) were determined for each vertebra from Th10 to L4. Ten patients had normal scintigrams. No change in MDP uptake or BMD was seen after 6 months in these patients. Of the seven patients with abnormal scintigrams, one patient had a clinical sign of progression with an increase in both MDP uptake and BMD. The remaining six patients showed stable or improved clinical status. For their abnormal vertebrae a decrease in MDP uptake was seen, while BMD varied in different ways after 6 months. For the normal vertebrae in these patients with metastatic involvement, no change in MDP uptake was seen. However, the BMD values showed a decrease, indicating a generalized increase in bone resorption at sites distant from the metastases.     

Additional information from Quantitative 24-Hour 99MTc-Mdp Bone Scintigraphy in Patients with Prostatic Carcinoma

Quantitative bone scintigraphy was performed at 4 and 24 h after injection of ^99mTc-MDP. the lower thoracic and all the lumbar vertebrae were recorded in 37 patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months postoperatively. Fourteen patients had normal bone scintigrams. By means of the measured variation in the count rate between normal vertebrae, the criterion for a vertebra to be considered as abnormal was determined using the 4h-uptake values. for patients with normal scintigrams the count rate at 24 h was below the 4h level and the mean 24h/4h ratio was determined to be 0.85 ± 0.09 (1 SD). Normal vertebrae in patients with skeletal metastases had only slightly lower count rate values at 24 h than at 4 h. Abnormal vertebrae showed a higher count rate at 24 h, especially two weeks postoperatively, while a tendency towards lower values than at 4 h was seen after 6 months. If the 24 h/4 h ratio is used as an extra criterion to the count rate at 4 h, the vertebrae will be more accurately defined as normal or abnormal.     

Chronic lateral instability of the ankle Roentgen stereophotogrammetry of talar position

Using roentgen stereophotogrammetric analysis (RSA), we investigated the talar mobility in 54 ankles during the anterior drawer and adduction tests. Talar tilt was increased in ankles with unilateral symptoms of chronic lateral instability. No other difference in talar tilt and anterior drawer sign was noted comparing ankles with and without symptoms.

We conclude that mechanical tests cannot always verify the diagnosis “chronic lateral instability of the ankle “.     

Reconstruction for lateral ligament injuries of the ankle

Seventy-six patients (83 ankles) with chronic lateral instability of the ankle were treated by a simple reconstructive operation, namely, a subperiosteal release on the distal part of the lateral malleolus. The released flap, including the insertion of both the anterior talofibular and the calcaneofibular ligaments, was reattached to the malleolus more proximally. Seventy-five patients (82 ankles) were examined at a mean of 24 months (range 12 to 70) after operation. In 78 ankles (95%) the result was excellent or good. Forty-four of the 51 patients (86%) whose sporting activities were restricted before operation had no restriction at follow-up. Recurrence of instability occurred in one ankle, following a further injury two years after operation.     

Radionuclide left ventricular volume determination. Influence of scattered radiation and surrounding activity

Summary. Radionuclide measurements of left ventricular volumes, ejection fractions and stroke volumes were performed by an equilibrium technique in nine patients using left anterior oblique projection and individual depth correction. Phantom studies were made in order to evaluate attenuation and scattering of the radiation. It was found that a simple depth correction factor, k(d)= e^μd, can be used under certain conditions. However, the determination of left ventricular volume by radionuclide techniques is not a truly absolute method. The depth correction factor to be used is dependent on the condition of measuring and evaluation, for instance how the region of interest for the left ventricle is selected. Therefore, this method should be carefully standardized, evaluated and compared to other techniques. Stroke volume measured by radionuclide and dye-dilution technique showed a correlation coefficient of 0·76 (nine patients) at rest and 0·77 (seven patients) at work. This method can be easily performed during routine ejection fraction determination and can thus be useful in clinical studies.     

The Trauma Recovery Group: A Cognitive-Behavioral Program for Post-Traumatic Stress Disorder in Persons with Severe Mental Illness

To address the problem of post-traumatic stress disorder (PTSD) in severe mental illness, the Trauma Recovery Group, a mixed gender cognitive-behavioral program, was developed and piloted at a community mental health center. The 21-week program includes breathing retraining, education about PTSD, cognitive restructuring, coping with symptoms, and making a recovery plan. Eighty clients were assessed at baseline and 41 provided follow-up data. Retention in the group was good: 59%. Treatment completers improved significantly in PTSD symptoms and diagnosis, depression, and post-traumatic cognitions, but dropouts did not. The results support the feasibility of the program and suggest it produces clinical benefits. Kim T. Mueser and Elisa Bolton are affiliated with the Department of Psychiatry, Dartmouth Medical School, New Hampshire-Dartmouth Psychiatric Research Center, 105 Pleasant St., Concord, NH, 03301, USA. Patricia C. Carty, Michael J.Bradley, Kimberly F. Ahlgren, Diane R. DiStaso, Andrew Gilbride, Carol Liddell are affiliated with The Mental Health Center of Greater Manchester, Manchester, NH, USA     

Multiple sclerosis immunopathic trait and HLA-DR(2)15 as independent risk factors in multiple sclerosis

We analysed HLA haplotypes in pairs of 78 sporadic multiple sclerosis (MS) patients and 78 healthy siblings. The presence of 2 oligoclonal IgG bands, detected by immunoblotting of the cerebrospinal fluid in healthy siblings, has previously been defined as MS immunopathic trait (MSIT), based on a cut-off derived from healthy unrelated volunteers. The frequency of MSIT was 17.9% (n=14/78 siblings). The HLA-DR(15)2 allelle was present in 21.4% (n=3/14) of the siblings with MSIT, in 40.6% (n =26/64) of the siblings without MSIT, and in 59% (n =46/78) of the patients with clinically-definite (CD) MS. The distribution of zero, one or two HLA-DR(2)15 alleles was significantly skewed towards a lower allelle count in the siblings with MSIT compared with the group of unrelated siblings with MS (P=0.002), and also lower than their related siblings with MS (P=0.1). These results suggest that the MS susceptibility gene, HLA-DR(2)15 type, does not induce MSIT, and conceivably these are two separate risk factors in the development of MS. The effect of HLA-DR(2)15 and MSIT in sporadic MS appears to be synergistic.     

Birth weight and risk of cancer

BACKGROUND: It is well established that prenatal biologic processes are important for the development of some childhood cancers, whereas less is known regarding their influence on adult cancer risk. High birth weight has been associated with risk of breast cancer, whereas studies of other specific cancers and all cancers together have been less conclusive. METHODS: The authors established a cohort of more than 200,000 men and women who were born between 1936 and 1975. Birth weights were obtained from school health records and information concerning cancer from the Danish Cancer Registry. Follow-up was performed between April 1, 1968 and December 31, 2003. During 6,975,553 person-years of follow-up, a total of 12,540 primary invasive cancers were diagnosed. RESULTS: Analyses of site-specific cancers revealed that the majority of cancers had a positive linear association with birth weight. Departures from a positive linear association were found to be statistically significant for cancers of the pancreas and bladder, which demonstrated a V-shaped association, and testicular cancer, which demonstrated an inverse association with birth weight. Excluding these 3 exceptions, the trends for the individual cancer sites were not heterogeneous, and the overall trend was a relative risk of 1.07 (95% confidence interval, 1.03-1.11) per 1000-g increase in birth weight. This trend was the same in men and women and in all age groups. CONCLUSIONS: A 7% increase in cancer risk was observed per 1000-g increase in birth weight. Few cancers demonstrated a nonlinear association with birth weight, and testicular cancer was found to be negatively associated with birth weight. The authors hypothesized that the biologic explanation behind the association between birth weight and cancer at different sites should be sought in a common pathway.     

Environmental Notes

Samples of vertebral bone were obtained by skeletal biopsy and lead concentrations were determined by atomic absorption spectroscopy. The median level of lead in bone in 27 active lead workers was 29 μg/g wet weight (range 2–155), corresponding to 370 μg/g calcium (range 30–1, 120). In 9 retired workers, the corresponding levels were 19 μg/g (5–76) and 250 μg/g calcium (60–700); in 14 reference subjects without occupational exposure, 1.3 μg/g (1–4) and 13 μg/g calcium (8–40). The bone lead content rose with time of exposure. Comparison of levels in vertebra with those in fingerbone, as measured by in vivo x-ray fluorescence in the same subjects, strongly suggested the presence of lead pools with different kinetics. The accumulation pattern, as well as the relation between levels in vertebra and fingerbone, suggests a much shorter half-time of lead in the mainly trabecular vertebral bone as compared to the mainly cortical fingerbone. Further, there was an association between vertebral and blood lead levels in the retired workers, which shows a considerable endogenous lead exposure from the skeletal pool.