The mechanism of an osteoporosis center

The cost of osteoporosis to the quality of human life and well-being are immeasurable; its costs to society are significant. Osteoporosis affects approximately 20 million Americans and has been estimated by the National Osteoporosis Foundation to equal $7 to $10 billion in health care costs and productivity annually. Osteoporosis represents a major health problem. Clearly, a screening and bone maintenance program can be managed by nurses in a cost-effective manner and serves as an efficient facilitator in the education and care of patients. Furthermore, an osteoporosis center can provide invaluable support for professionals in various disciplines of medicine. In our experience at The Hospital for Special Surgery most of our patients come to our center as a result of a physician referral. An average of 600 to 800 patients are seen annually and about 15 per cent of these patients are referred from the screening program to a metabolic bone treatment source. Approximately 5 per cent of patients referred for treatment are hospitalized for an extensive evaluation which includes an iliac crest-bone biopsy. As the patient population in the Osteoporosis Center has grown there has been a recognition of special patient groups who have specific needs. This has resulted in the establishment of clinics which address the problems associated with patients who are renal stone formers, anorexic, and amenorheic (many of this latter group are athletes or dancers).(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinico-roentgenological and physiological evaluation of the spine in patients with juvenile kyphosis

203 patients with juvenile kyphosis, aged 11-16 years, have been subjected to the complex examination, including ++clinico-roentgenologic and physiologic methods. Along with the cardinal signs, common for juvenile kyphosis diagnosis and characteristic of the dystrophic process (wedge distortion, osteoporosis of vertebra bodies and fragmentation of their apophyses, dedifferentiation of the bone structure, height reduction and pathologic restructuring of intervertebral disks following the pattern of fibrosis, presence of discal hernia), the signs of bone ++ dysplasia of spine and skeleton in general should be singled out of the roentgenologic characteristic of disease which determine the variants of pathologic process course and treatment tactics. The presence of dysontogenesis signs in patients with juvenile kyphosis is suggested.     

The Goodwin sound: an aid in treating obliterated membranous urethral strictures endoscopically

The treatment options for a man with obliteration of the membranous urethra are many today because of the great progress that has been made in the past 40 years. No one procedure is likely to be ideal for all situations. Pullthrough, two-stage scrotal inlay, and transpubic or perineal approaches can be applied with success. Endoscopic treatment can also be used with satisfactory results and less morbidity in selected patients. A failed endoscopic attempt should not interfere with a subsequent open procedure. Conversely, a failed open procedure may be remedied by endoscopic surgery. We feel our technique is simpler than other reported endoscopic techniques, as it requires only one urologist, and it does not require fluoroscopy or endoscopy from above. Significantly, it provides a guide to cut on that relieves the fear of inadvertent incision into the rectum.     

Percutaneous removal of renal and upper ureteral stones: clinical results and complications of 103 cases

We report the results and complications of 103 consecutive patients who underwent percutaneous removal of renal and ureteral stones. The overall clinical success rate was 80.6%. For the recent 33 cases in which UL-arm fluoroscopy was used, however, the success rate was as high as 87.9%, which was considered to be due to easier establishment of percutaneous direct access. The most common complications were bleeding (18.5%), extravasation (15.5%) and fever (9.7%). Four cases with significant bleeding required arteriography, but there were no sign of arteriovenous fistula nor pseudoaneurysms in any cases. To study renal parenchymal damage in the percutaneous procedures, plasma renin activities (PRA) were compared in 54 cases after six months. However, significant elevation of PRA did not occur in any case.     

A case of embryonal carcinoma arising in the basal ganglia of the cerebrum]

The occurrence sites of intracranial primary germ cell tumors are most often the pineal and suprasellar regions. The histological type observed most frequently in these tumors is germinoma. Cases of embryonal carcinoma arising in the basal ganglia are rarely reported. To our knowledge, only 4 such cases have been previously reported in the literature. A case of an embryonal carcinoma arising in the basal ganglia is reported. A 17-year-old boy was admitted to our hospital on July 30, 1988 because of headache and vomiting, and a right hemiparesis. On admission, physical inspection showed no abnormalities and neurological examination revealed obtunded consciousness, a right central facial paresis and a right hemiparesis with Hoffman and Babinski reflexes. Noncontrast CT scan showed a large mass of low-to slightly high-density in the region of the left basal ganglia accompanied with midline shift and ventricular dilatation. Enhancement of the lesion was made by contrast CT scan. It was not homogeneous. Cerebral angiogram displayed a contralateral shift and an unrolling of the anterior cerebral artery, a lateral stretch of middle cerebral artery, a downward stretch of anterior choroidal artery and a tumor stain fed by the Heubner artery. On August 3, left frontotemporal craniotomy was performed. The tumor was totally removed in a piecemeal manner using microsurgical techniques. Histopathological diagnosis was mixed-type of germ cell tumor comprising embryonal carcinoma and teratoma. Postoperative CT scan showed complete disappearance of the tumor. A course of radiation of 4950 rads and two courses of a combination chemotherapy with cis-platinum, vinblastine and bleomycin were given within 3 months after the operation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Decreased blood perfusion in canine tibial diaphysis after filling with acrylic bone cement compared with inert bone wax

Sixteen dogs had one tibia filled with acrylic PMMA bone cement and the opposite, control tibia filled with inert bone wax. After 1, 4, and 12 weeks, the blood perfusion in diaphyses was measured with Sc-46 labeled microspheres. The blood flow rates increased from 1 to 4 weeks and dropped to about the 1-week level after 12 weeks on both sides, with the acrylic side lower than the control side. On both sides, Disulphine Blue staining of the bones showed severe endosteal avascularity after 1 and 4 weeks and massive periosteal apposition after 4 and 12 weeks. The initial increase in blood flow is considered due to periosteal apposition, and the differences in blood flow rates are attributed to avascularity caused by the polymerization heat and toxicity of the acrylic cement.     

Interstitial hyperthermia of malignant brain tumors using implant heating system (IHS)

We have developed an implant heating system (IHS) for interstitial hyperthermia of brain tumors. IHS consists of three compartments: ferromagnetic implant with low Curie point, induction coil and generator to produce high frequency magnetic field. The device works as follows: It is heated up to a Curie temperature (Tc) by Eddy current under the magnetic field. Heat generated in the implant is conducted to the tumor tissue into which it has been implanted. To evaluate the effect of this hyperthermia, a brain tumor model was produced by innoculation of VX2 tumor cells and treated either by hyperthermia with IHS alone, chemotherapy with ACNU alone, or with a combination of both. The longest survival was obtained by the combined treatment, and significant prolongation of survival was found in the single treatment groups. In the Phase I clinical trial, one or several implants (1.8 mm X 15 mm, Tc = 68 degrees C) made of Fe-Pt alloy were placed in the tumor by CT guided stereotactic procedure, or manually during craniotomy. Hyperthermia of above 42 degrees C for 30 to 60 minutes twice a week was brought about in ten cases of malignant brain tumor. CT evaluation was made in nine cases treated for more than ten times in this way. Five out of the nine cases responded to this hyperthermia with irradiation. In conclusion, a safe, repeated and longterm treatment was possible without significant side effects. The hyperthermia with IHS may also be applicable to benign intracranial tumors and neoplasms in other part of body as well.     

Risk factors for diabetic retinopathy in children and adolescents with type I diabetes mellitus

Based on repeated fluoroangiographic examinations in a group of 28 children with type I diabetes mellitus the authors observed progressing diabetic retinal changes. At the end of the three-year observation period they found progress in 32% of the children. They investigated influence of risk factors such as age, duration of the basic disease, its metabolic compensation, sex and HLA typing on the development of diabetic retinopathy.     

Effects of monocular enucleation, tetrodotoxin, and lid suture on cytochrome-oxidase reactivity in supragranular puffs of adult macaque striate cortex

The laminar structure and cellular distribution of cytochrome-oxidase (CO) reactivity in supragranular puffs of striate cortex was examined in adult macaque monkeys surviving various periods of monocular enucleation, lid suture, and retinal impulse blockage with tetrodotoxin (TTX). Enucleation and TTX produced a rapid and severe loss in the size of the CO reactive region in puffs dominated by the removed or treated eye compared to slower and less marked reductions obtained in deprived puffs of lid-sutured monkeys. In all deprived animals, the cross-sectional areas of deprived puffs decreased most rapidly in the upper layers (2 and 3A). In long-term enucleated (60 wks) and TTX-treated (4 wks) monkeys, puff area was severely reduced in layer 3B, while reactivity in layer 3B appeared partially spared in lid-sutured monkeys. The density of the CO reaction product was significantly and evenly reduced throughout deprived puffs for all of the monkeys examined; however, this decrease was less severe in adult monkeys lid-sutured for 11 wks. Although no evidence for cell loss was obtained, all three forms of visual deprivation led to lower counts of neuronal perikarya with high levels of CO reaction product in both deprived puff and interpuff areas. This effect was less marked in the deprived puffs of monkeys lid-sutured for 2.5 and 3 yrs, suggesting recovery of CO activity in some neurons. Neurons in deprived puffs and interpuffs were generally similar in size to those in nondeprived regions, although CO-reactive cells were significantly smaller in the deprived puffs of monkeys enucleated for 28.5 or 60 wks. These results indicate that the metabolic response of neuronal elements in supragranular striate cortex depends upon the nature of the visual deficit. The partial sparing of CO reactivity in deprived puffs of lid-sutured monkeys may reflect the continued transmission of certain types of visual stimuli through a closed eyelid.