Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography

To determine the efficacy of magnetic resonance (MR) imaging and myelography for the diagnosis of spinal cord compression due to metastatic disease, the authors prospectively examined 70 patients who had known or suspected spinal involvement by malignancy. Most MR examinations consisted of T1-weighted sagittal imaging of the entire spine, with additional sequences as needed for clarification. Extradural masses were found in 46 patients, 25 of whom had cord compression. For extradural masses causing cord compression, the sensitivity and specificity of MR imaging was .92 and .90, respectively, compared with .95 and .88 for myelography. For extradural masses without cord compression the sensitivity and specificity of MR imaging was .73 and .90, versus .49 and .88 for myelography. MR imaging was much more sensitive for metastases to bone (.90 vs .49), as expected. MR imaging is an acceptable alternative to myelography for diagnosing spinal cord compression and is preferable as a first study because it is noninvasive and better tolerated.     

Pharmacokinetics in obese patients

One of the many problems in providing anaesthesia for morbidlyobese patients is the influence of obesity on pharmacokineticsand pharmacodynamics. Drug administration in obese patientsis difficult because recommended doses are based on pharmacokineticdata obtained from individuals with normal weights; therefore,mistakes in the determination of the appropriate dose are oftenmade. Because of comorbidity in these patients, the functionof organs involved in drug elimination (e.g. kidney, liver)can be affected making pharmacokinetics more difficult and complex.     

Serial lung scintigraphy: utility in diagnosis of pulmonary embolism

Pairs of sequential perfusion lung scans and pulmonary angiograms obtained in 45 patients were reviewed to investigate the utility of short-term, sequential scintigraphy in the diagnosis of pulmonary embolism (PE). Forty-six sequential scan pairs were reviewed; 13 were ventilation-perfusion (V-P) pairs. Angiograms were obtained within 48 hours of either the first (65%) or second (35%) perfusion scan in each pair. Sequential scintigraphic patterns were classified as showing change (i.e., improvement in defects, new defects), no change, or as being indeterminate. A changing perfusion pattern was associated with a high (20/23) likelihood of PE, but seven of 16 patients with stable perfusion patterns also had PE. The sensitivity of a changing perfusion pattern for PE was 0.74 (20/27) and its specificity was 0.75 (9/12). In two of six patients who had serial V-P studies that showed changing perfusion defects, there were matched changes in regional ventilation and angiograms were negative. The findings suggest that short-term serial perfusion lung scanning may aid the scintigraphic diagnosis of PE in certain circumstances. Serial V-P imaging is needed, however, to maximize diagnostic specificity.     

Erosive potential of beverages sold in Australian schools

Background:  Dental erosion is an increasingly prevalent problem in Australia. The aim of this study was to analyse the composition and erosive potential of beverages sold for consumption in Victorian schools.
Methods:  Fifteen drinks were selected and analysed to determine their pH, titratable acidity and ionic composition (calcium, fluoride and inorganic phosphate). The erosive potential of the beverages was measured by analysing weight loss, surface loss and the release of calcium ions from human enamel following a 30-minute or 24-hour exposure. The association of the chemical parameters with the measures of erosion was determined using Spearman's rank correlation.
Results:  All beverages tested except the milks and the bottled water produced significant dental erosion in vitro . The only chemical parameter that correlated significantly with all measures of erosion was the initial pH of the beverage (p < 0.01). Levels of fluoride similar to those of Australian reticulated water were found in the carbonated beverages.
Conclusions:  The majority of the tested beverages sold from school canteens exhibited erosive potential.     

Chemical and biomechanical characterization of hyperhomocysteinemic bone disease in an animal model

Background

Classical homocystinuria is an autosomal recessive disorder caused by cystathionine β-synthase (CBS) deficiency and characterized by distinctive alterations of bone growth and skeletal development. Skeletal changes include a reduction in bone density, making it a potentially attractive model for the study of idiopathic osteoporosis.

Methods

To investigate this aspect of hyperhomocysteinemia, we supplemented developing chicks (n = 8) with 0.6% dl-homocysteine (hCySH) for the first 8 weeks of life in comparison to controls (n = 10), and studied biochemical, biomechanical and morphologic effects of this nutritional intervention.

Results

hCySH-fed animals grew faster and had longer tibiae at the end of the study. Plasma levels of hCySH, methionine, cystathionine, and inorganic sulfate were higher, but calcium, phosphate, and other indices of osteoblast metabolism were not different. Radiographs of the lower limbs showed generalized osteopenia and accelerated epiphyseal ossification with distinct metaphyseal and suprametaphyseal lucencies similar to those found in human homocystinurics. Although biomechanical testing of the tibiae, including maximal load to failure and bone stiffness, indicated stronger bone, strength was proportional to the increased length and cortical thickness in the hCySH-supplemented group. Bone ash weights and IR-spectroscopy of cortical bone showed no difference in mineral content, but there were higher Ca²⁺/PO₄^3- and lower Ca²⁺/CO₃^2- molar ratios than in controls. Mineral crystallization was unchanged.

Conclusion

In this chick model, hyperhomocysteinemia causes greater radial and longitudinal bone growth, despite normal indices of bone formation. Although there is also evidence for an abnormal matrix and altered bone composition, our finding of normal biomechanical bone strength, once corrected for altered morphometry, suggests that any increase in the risk of long bone fracture in human hyperhomocysteinemic disease is small. We also conclude that the hCySH-supplemented chick is a promising model for study of the connective tissue abnormalities associated with homocystinuria and an important alternative model to the CBS knock-out mouse.